Presentation on theme: "Management of Pleural effusions HUEH 2011 Terry Flotte, MD"— Presentation transcript:
1 Management of Pleural effusions HUEH 2011 Terry Flotte, MD To Edit the Date go to View> Slide MasterOn the Title Slide Master, select the text box with the date and edit.
2 Case Presentation4 year-old female presents with 5 days of fever, worsening tachypnea, some abdominal pain.Temp 40.2C, RR 48, pulse oximetry 89%Absent breath sounds and dullness right lung baseDecrease in whispered pectorloquy, vocal fremitus
18 Tuberculous Effusions Thought to arise from rupture of subpleural caseous focusFrequent in early, untreated cases, with concomitant HIVMeets criteria of Exudative Effusion but with a greater proportion of lymphocytes in fluidPleural fluid smears and cultures are often negative
21 A few notes about chylothorax Most common cause of neonatal effusionBirth trauma to Thoracic ductCongenitalPost-surgical or other traumaAssociated with lymphangiomatosisIatrogenic with central venous infusion of lipid
22 Management of Chylothorax Maintaining Nutrition and Reducing the Volume of Chyle Circulation Dietary: medium-chain triglyceride diet or total parenteral nutrition Octreotide Relieving Dyspnea by Removing Chyle from the Pleural Cavity Thoracentesis (short term only) Tube thoracostomy (short term only) Pleuroperitoneal or pleurovenous shunting Pleurodesis Treatment of the Underlying Defect Thoracic duct embolization Ligation of the thoracic duct (thoracoscopy or thoracotomy) Clipping or fibrin glue to the thoracic duct leak Radiotherapy for mediastinal lymphoma
23 Sources Murray and Nadel’s Textbook of Pulmonary Diseases Diseases of the PleuraNelson’s Pediatrics