Sunday, 24 November 2013

Pleural disease – Pleural effusion – The Risk factors

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
B. Pleural effusion
It is a condition of collection of fluid within the pleural cavity as a result of heart failure, bleeding (hemothorax), infections, excessive or decreased fluid volume, etc.
B.2.2. Risk factors
1. Certain Medications
Certain medication such as Nitrofurantoin (Macrodantin, Furadantin, Macrobid), Dantrolene (Dantrium), Methysergide (Sansert), etc. are associsted to increased riak of pleural effusions.
2. Radiation therapy
There is a report of Therapy of pronounced pleural and pericardial effusion in metastatic breast cancer with local mitoxantrone and radiation therapy(28).
3. Acute Lung Injury
Pleural effusion is a frequent finding in patients with acute respiratory distress syndrome. Pleural effusion in acute lung injury or acute respiratory distress syndrome patients is of modest entity and leads to a greater chest wall expansion than lung reduction, without affecting gas exchange or respiratory mechanics, according to the study(29).
4. Nonaccidental trauma (NAT)
Nonaccidental trauma (NAT) is common and presents with varied symptoms..There is a reprot of a case of a of a 10-week-old infant who presented with multiple nonspecific complaints that included respiratory distress, refusal to feed, constipation, and lethargy. Sepsis was the working diagnosis on admission, but a massive pleural effusion and rib fractures seen on chest imaging ultimately led to the diagnosis of nonaccidental trauma(30).
5. Critically ill patients
Pleural effusions (PEs) are common in critically ill patients mainly as a consequence of severe cardiopulmonary disorders frequently encountered in these patients, according to the Medical School, Democritus University of Thrace(31)
6. Blunt thoracoabdominal trauma
Patients wirh blunt thoracoabdominal trauma are associated to higher risk to develop pleural effusions. There is a report of a successful treatment result in a rare case of hepatitis C virus-related cirrhosis, who had sustained hydrothorax after blunt thoracoabdominal trauma. She sustained blunt thoracoabdominal trauma with a left clavicle fracture dislocation and right rib fractures. There was no hemopneumothorax at initial presentation. However, dyspnea and right pleural effusion developed gradually, according to the study by the Taipei-Veterans General Hospital(32).
7. Pregnancy
There is a report of a 40 year old woman at 30 weeks of her eighth pregnancy presented with acute onset of dyspnoea and a large left pleural effusion after the onset of premature labour. A barium enema showed diaphragmatic rupture with intestinal contents in the thorax(33)
7. Other risk factors
According to the study by the, most patients with pleural empyema and complicated parapneumonic pleural effusion were middle aged (53+/-17 years); men were twice as likely as women to have these conditions. Less than half (46%) of patients had at least one risk factor such as neoplasia (37%), treatment with immunosuppressive medicine (15%), alcohol abuse (15%)(34).
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