Etiologies of bilateral pleural effusions

Jonathan T. Puchalski*, A. Christine Argento, Terrence E. Murphy, Katy L B Araujo, Isabel B. Oliva, Ami N. Rubinowitz, Margaret A. Pisani

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: To evaluate the safety, etiology and outcomes of patients undergoing bilateral thoracentesis. Methods: This is a prospective cohort study of 100 consecutive patients who underwent bilateral thoracenteses in an academic medical center from July 2009 through November 2010. Pleural fluid characteristics and etiologies of the effusions were assessed. Mean differences in levels of fluid characteristics between right and left lungs were tested. Associations between fluid characteristics and occurrence of bilateral malignant effusions were evaluated. The rate of pneumothorax and other complications subsequent to bilateral thoracentesis was determined. Results: Exudates were more common than transudates, and most effusions had multiple etiologies, with 83% having two or more etiologies. Bilateral malignant effusions occurred in 19 patients, were the most common single etiology of exudative effusions, and were associated with higher levels of protein and LDH in the pleural fluid. Among 200 thoracenteses performed with a bilateral procedure, seven resulted in pneumothoraces, three of which required chest tube drainage and four were ex vacuo. Conclusions: More often than not, there are multiple etiologies that contribute to pleural fluid formation, and of the combinations of etiologies observed congestive heart failure was the most frequent contributor. Exudative effusions are more common than transudates when bilateral effusions are present. Malignancy is a common etiology of exudative effusions. This study suggests that the overall complication rate following bilateral thoracentesis is low and the rate of pneumothorax subsequent to bilateral thoracentesis is comparable to unilateral thoracentesis.

Original languageEnglish (US)
Pages (from-to)284-291
Number of pages8
JournalRespiratory Medicine
Volume107
Issue number2
DOIs
StatePublished - Feb 1 2013

Fingerprint

Pleural Effusion
Pneumothorax
Exudates and Transudates
Chest Tubes
Thoracentesis
Drainage
Cohort Studies
Heart Failure
Prospective Studies
Safety
Lung
Neoplasms
Proteins

Keywords

  • Effusion
  • Malignancy
  • Pneumothorax
  • Thoracic disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Puchalski, J. T., Argento, A. C., Murphy, T. E., Araujo, K. L. B., Oliva, I. B., Rubinowitz, A. N., & Pisani, M. A. (2013). Etiologies of bilateral pleural effusions. Respiratory Medicine, 107(2), 284-291. https://doi.org/10.1016/j.rmed.2012.10.004
Puchalski, Jonathan T. ; Argento, A. Christine ; Murphy, Terrence E. ; Araujo, Katy L B ; Oliva, Isabel B. ; Rubinowitz, Ami N. ; Pisani, Margaret A. / Etiologies of bilateral pleural effusions. In: Respiratory Medicine. 2013 ; Vol. 107, No. 2. pp. 284-291.
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Puchalski, JT, Argento, AC, Murphy, TE, Araujo, KLB, Oliva, IB, Rubinowitz, AN & Pisani, MA 2013, 'Etiologies of bilateral pleural effusions', Respiratory Medicine, vol. 107, no. 2, pp. 284-291. https://doi.org/10.1016/j.rmed.2012.10.004

Etiologies of bilateral pleural effusions. / Puchalski, Jonathan T.; Argento, A. Christine; Murphy, Terrence E.; Araujo, Katy L B; Oliva, Isabel B.; Rubinowitz, Ami N.; Pisani, Margaret A.

In: Respiratory Medicine, Vol. 107, No. 2, 01.02.2013, p. 284-291.

Research output: Contribution to journalArticle

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T1 - Etiologies of bilateral pleural effusions

AU - Puchalski, Jonathan T.

AU - Argento, A. Christine

AU - Murphy, Terrence E.

AU - Araujo, Katy L B

AU - Oliva, Isabel B.

AU - Rubinowitz, Ami N.

AU - Pisani, Margaret A.

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N2 - Background: To evaluate the safety, etiology and outcomes of patients undergoing bilateral thoracentesis. Methods: This is a prospective cohort study of 100 consecutive patients who underwent bilateral thoracenteses in an academic medical center from July 2009 through November 2010. Pleural fluid characteristics and etiologies of the effusions were assessed. Mean differences in levels of fluid characteristics between right and left lungs were tested. Associations between fluid characteristics and occurrence of bilateral malignant effusions were evaluated. The rate of pneumothorax and other complications subsequent to bilateral thoracentesis was determined. Results: Exudates were more common than transudates, and most effusions had multiple etiologies, with 83% having two or more etiologies. Bilateral malignant effusions occurred in 19 patients, were the most common single etiology of exudative effusions, and were associated with higher levels of protein and LDH in the pleural fluid. Among 200 thoracenteses performed with a bilateral procedure, seven resulted in pneumothoraces, three of which required chest tube drainage and four were ex vacuo. Conclusions: More often than not, there are multiple etiologies that contribute to pleural fluid formation, and of the combinations of etiologies observed congestive heart failure was the most frequent contributor. Exudative effusions are more common than transudates when bilateral effusions are present. Malignancy is a common etiology of exudative effusions. This study suggests that the overall complication rate following bilateral thoracentesis is low and the rate of pneumothorax subsequent to bilateral thoracentesis is comparable to unilateral thoracentesis.

AB - Background: To evaluate the safety, etiology and outcomes of patients undergoing bilateral thoracentesis. Methods: This is a prospective cohort study of 100 consecutive patients who underwent bilateral thoracenteses in an academic medical center from July 2009 through November 2010. Pleural fluid characteristics and etiologies of the effusions were assessed. Mean differences in levels of fluid characteristics between right and left lungs were tested. Associations between fluid characteristics and occurrence of bilateral malignant effusions were evaluated. The rate of pneumothorax and other complications subsequent to bilateral thoracentesis was determined. Results: Exudates were more common than transudates, and most effusions had multiple etiologies, with 83% having two or more etiologies. Bilateral malignant effusions occurred in 19 patients, were the most common single etiology of exudative effusions, and were associated with higher levels of protein and LDH in the pleural fluid. Among 200 thoracenteses performed with a bilateral procedure, seven resulted in pneumothoraces, three of which required chest tube drainage and four were ex vacuo. Conclusions: More often than not, there are multiple etiologies that contribute to pleural fluid formation, and of the combinations of etiologies observed congestive heart failure was the most frequent contributor. Exudative effusions are more common than transudates when bilateral effusions are present. Malignancy is a common etiology of exudative effusions. This study suggests that the overall complication rate following bilateral thoracentesis is low and the rate of pneumothorax subsequent to bilateral thoracentesis is comparable to unilateral thoracentesis.

KW - Effusion

KW - Malignancy

KW - Pneumothorax

KW - Thoracic disease

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Puchalski JT, Argento AC, Murphy TE, Araujo KLB, Oliva IB, Rubinowitz AN et al. Etiologies of bilateral pleural effusions. Respiratory Medicine. 2013 Feb 1;107(2):284-291. https://doi.org/10.1016/j.rmed.2012.10.004