Pleurodesis: Difference between revisions
Rosie Swift (talk | contribs) No edit summary |
Rosie Swift (talk | contribs) No edit summary |
||
| Line 8: | Line 8: | ||
== Description == | == Description == | ||
A pleurodesis is a form of pleural surgery which aims to obliterate the pleural space between the visceral and parietal pleura. This involves | A pleurodesis is a form of pleural surgery which aims to obliterate the pleural space between the visceral and parietal pleura. This involves a chemical or surgical procedure to create an adhesion between the two pleura. | ||
Chemical pleurodesis: | * Chemical pleurodesis: This is done by inserting a sclerosing agent into the pleural cavity via a chest tube. The drug used causes the pleural surfaces to become sticky and bond together, therefore closing the pleural space. The type of sclerosing agent to be used depends on local expertise, availability and the underlying reason why the pleurodesis is required. Drugs used include: sterile medical talc, Tetracyclines (minocycline, doxycycline), Silver nitrate, Iodopovidone, Bleomycin, Corynebacterium parvum with parenteral methylprednisolone acetate, Erythromycin, Fluorouracil, Interferon beta, Autologous blood, Mitomycin C, Cisplatin, Cytarabine, Doxorubicin, Etoposide, Bevacizumab (intravenous or intrapleural) and Streptococcus pyogenes A3 (OK-432)<ref name=":0" /> | ||
Surgical | * Surgical pleurodesis: This is done through medical thoracoscopy, video-assisted thoracoscopy (VATS), or open thoracotomy, where either a sclerosis agent is placed in the pleural cavity or mechanical abrasion (also termed dry abrasion) is achieved by draining the pleural fluid using a tunnelled catheter (induces pleurodesis without instillation of a sclerosing agent). | ||
== Indication == | == Indication == | ||
| Line 20: | Line 20: | ||
The pleural space between the parietal and visceral pleura usually contains around 50ml of pleural fluid<ref>Ali M, Surani S. [https://www.ncbi.nlm.nih.gov/books/NBK560685/ Pleurodesis]. 2021. In: StatPearls [Internet]. Accessed 25 Mar 2022</ref>. Under pathological conditions, such as pneumothorax or pleural effusion, air or excess | The pleural space between the parietal and visceral pleura usually contains around 50ml of pleural fluid<ref name=":0">Ali M, Surani S. [https://www.ncbi.nlm.nih.gov/books/NBK560685/ Pleurodesis]. 2021. In: StatPearls [Internet]. Accessed 25 Mar 2022</ref>. Under pathological conditions, such as pneumothorax or pleural effusion, air or excess fluid can build up in the pleural space. If this becomes recurrent and significantly symptomatic, pleurodesis may be indicated. | ||
== Clinical Presentation == | == Clinical Presentation == | ||
| Line 37: | Line 37: | ||
== Pre-Op == | == Pre-Op == | ||
== | == Complications == | ||
Pleurectomy may be required to control malignant pleural effusions in patients who have failed chemical pleurodesis. | |||
Patients must be good surgical candidates and have a reasonably long expected survival because total radical pleurectomy/decortication requires a thoracotomy and is a major surgical procedure associated with considerable morbidity and some mortality. | |||
== Resources == | == Resources == | ||
</div> | </div> | ||
== References == | |||
Revision as of 05:03, 31 March 2022
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (31/03/2022)
Description[edit | edit source]
A pleurodesis is a form of pleural surgery which aims to obliterate the pleural space between the visceral and parietal pleura. This involves a chemical or surgical procedure to create an adhesion between the two pleura.
- Chemical pleurodesis: This is done by inserting a sclerosing agent into the pleural cavity via a chest tube. The drug used causes the pleural surfaces to become sticky and bond together, therefore closing the pleural space. The type of sclerosing agent to be used depends on local expertise, availability and the underlying reason why the pleurodesis is required. Drugs used include: sterile medical talc, Tetracyclines (minocycline, doxycycline), Silver nitrate, Iodopovidone, Bleomycin, Corynebacterium parvum with parenteral methylprednisolone acetate, Erythromycin, Fluorouracil, Interferon beta, Autologous blood, Mitomycin C, Cisplatin, Cytarabine, Doxorubicin, Etoposide, Bevacizumab (intravenous or intrapleural) and Streptococcus pyogenes A3 (OK-432)[1]
- Surgical pleurodesis: This is done through medical thoracoscopy, video-assisted thoracoscopy (VATS), or open thoracotomy, where either a sclerosis agent is placed in the pleural cavity or mechanical abrasion (also termed dry abrasion) is achieved by draining the pleural fluid using a tunnelled catheter (induces pleurodesis without instillation of a sclerosing agent).
Indication[edit | edit source]
- Recurrent pleural effusion, typically malignant
- Recurrent or persistent pneumothorax
The pleural space between the parietal and visceral pleura usually contains around 50ml of pleural fluid[1]. Under pathological conditions, such as pneumothorax or pleural effusion, air or excess fluid can build up in the pleural space. If this becomes recurrent and significantly symptomatic, pleurodesis may be indicated.
Clinical Presentation[edit | edit source]
Depending on the reason that the pleurodesis is required, patients may present with signs of pleural effusion or pneumothorax, such as:
- breathlessness
- chest pain
- cough
- fever
- tachycardia
- tachypnoea
- fatigue
Diagnostic Tests[edit | edit source]
Pre-Op[edit | edit source]
Complications[edit | edit source]
Pleurectomy may be required to control malignant pleural effusions in patients who have failed chemical pleurodesis.
Patients must be good surgical candidates and have a reasonably long expected survival because total radical pleurectomy/decortication requires a thoracotomy and is a major surgical procedure associated with considerable morbidity and some mortality.
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 Ali M, Surani S. Pleurodesis. 2021. In: StatPearls [Internet]. Accessed 25 Mar 2022
