1.Surgical Managementof Pleural Effusion

2. Thoracentesis A procedure to remove excess fluid in the pleural space Indications: Diagnostic: to classify effusion as exudative or transudative Therapeutic: palliation of dyspnea (not more than 1.5L in one sitting) Diagnostic sampling allows the collection of liquid formicrobiologic and cytologic studies 3. Thoracentesis video 4. Effusion due to Heart Failure most common cause of pleural effusion a diagnostic thoracentesis is done if: the effusions are not bilateral and comparable in size the patient is febrile the patient has pleuritic chest pain to verify that the effusion is transudative Otherwise the patients heart failure is treated If the effusion persists despite therapy, a diagnostic thoracentesis shouldbe done A pleural fluid N-terminal pro-brain natriuretic peptide (NT-proBNP)>1500 pg/mL is diagnostic of an effusion secondary to congestive heartfailure 5. Parapneumonic Effusions most common cause of exudative pleural effusion (bacterialpneumonias, lung abscess, bronchiectasis) The presence of free pleural fluid can be demonstrated with a lateraldecubitus radiograph, CT of the chest, or ultrasound If the free fluid separates the lung from the chest wall by >10 mm, atherapeutic thoracentesis should be performed A procedure more invasive than thoracentesis is needed if thefollowing factors are present: Loculated pleural fluid Pleural fluid pH