Tube thoracostomy: This is a procedure used when a patient does not respond to medical therapy after more than 5 days. Under real-time, fluoroscopic guidance, a chest tube is inserted through the second or third intercostal space, depending on the location of the effusion. Thoracostomy allows for evacuation of the pleural fluid as well as decompression of the lungs in the area of effusion. The tube is clamped for 4 to 6 hours to allow for drainage and is then unclamped. This procedure is contraindicated in patients with signs of intracardiac or intrathoracic bleeding, but it is the preferred technique for large effusions that are not responsive to other therapies.
1. A thoracentesis to establish a diagnosis and re-expand the lung;
2. Thoracostomy tube drainage;
3. An indwelling pleural catheter (PleurX catheter);
4. Video-assisted thoracic surgery (VATS) combined with talc pleurodesis;
5. VATS with pleurodesis (VATS+PTx).
1. Pleurectomy/decortication/pleurodesis - in patients with large, symptomatic effusions, in which a benign tumor, e.g., lipoma, is found, or in patients who have to undergo subsequent lung transplantation, decortication of the lung may be the best choice.
5. Pleurodesis: A therapeutic pleurodesis is indicated in patients with a malignant pleural effusion that is not responsive to conservative treatment or in patients who show a clinical improvement after a surgical drain.
2. Surgical drainage: In case of the presence of clinical symptoms of dyspnea, pain, cough, anxiety, and other symptoms, a surgical drainage is the treatment of choice. This procedure does not cure the disease, but removes the effusion and prevents its re-accumulation.
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