Self-Study Resources-Feller-Kopman, Pleural Disease, NEJM 2019

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The review article from The New England Journal of Medicine discusses various aspects of pleural diseases. The pleura comprise the visceral pleura covering the lungs and the parietal pleura lining the chest wall. Pleural effusion, an abnormal accumulation of fluid in the pleural space, affects over 1.5 million patients annually in the U.S., primarily due to congestive heart failure, pneumonia, and cancer. The article highlights advances in the understanding and treatment of pleural diseases, focusing on expeditious, minimally invasive interventions that improve quality of life and reduce hospital stays.<br /><br />Pleural effusions can be classified as transudative or exudative. Transudative effusions are typically caused by systemic conditions like heart failure or cirrhosis, while exudative effusions often result from infections, malignancies, or inflammatory conditions. Significant emphasis is placed on differentiating these using Light's criteria and other diagnostic markers such as NT-proBNP levels.<br /><br />The review also covers the clinical management of pleural effusions, advocating the use of ultrasonography to guide diagnostic and therapeutic procedures due to its higher precision and lower complication rate compared to traditional radiographic methods. The article underscores the importance of prompt and accurate diagnosis, especially in cases that could lead to higher morbidity and mortality, such as empyema (pus in the pleural space) and malignant pleural effusions.<br /><br />For malignant effusions, which have a poor prognosis, the article suggests interventions like pleurodesis and tunneled pleural catheters to relieve symptoms and improve the quality of life. Additionally, the management of spontaneous pneumothorax and iatrogenic pneumothorax is discussed, highlighting newer, less invasive methods and the importance of surgical intervention when necessary.<br /><br />The article encourages ongoing research and improvements in diagnostic and therapeutic approaches to pleural disease, aiming for better patient outcomes through multidisciplinary care approaches.

Meta Tag

Asset Type PDF

Curriculum Category Pulmonary Disease in Critical Care

Keywords

pleural diseases

pleural effusion

visceral pleura

parietal pleura

transudative effusions

exudative effusions

ultrasonography

malignant pleural effusions

pleurodesis

spontaneous pneumothorax