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Empyema and Effusion: Outcome of Image-Guided Small-Bore Catheter Drainage

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Abstract

Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, catheter outcome, pleural fluid outcome, reinsertion rates, and need for urokinase or surgery recorded. Ninety-three small-bore chest drains (mean=10.2 Fr; range, 8.2–12.2 Fr) were inserted, with an average dwell time of 7.81 days for empyemas and 7.14 days for effusions (p > 0.05). Elective removal rates (73% empyema vs 86% effusions) and dislodgement rates (12% empyema vs 13% effusions) were similar for both groups. Eight percent of catheters became blocked and 17% necessitated reinsertion in empyemas, with no catheters blocked or requiring reinsertion in effusions (p < 0.05). Thirty-two patients (51%) required urokinase in the empyema group, versus 2 patients (6%) in the effusion group (p < 0.05). All treatment failures, requiring surgery, occurred in the empyema group (19%; n = 12; p < 0.05). In conclusion, noninfected pleural collections are adequately treated with small-bore catheters, however, empyemas have a failure rate of 19%. The threshold for using urokinase and larger-bore catheters should be low in empyema.

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Authors and Affiliations

  1. Department of Academic Radiology, Beaumont Hospital, Dublin 9, Ireland

    A. N. Keeling, S. Leong, P. M. Logan & M. J. Lee

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  1. A. N. Keeling
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  2. S. Leong
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  3. P. M. Logan
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  4. M. J. Lee
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Correspondence to M. J. Lee.

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Keeling, A.N., Leong, S., Logan, P.M. et al. Empyema and Effusion: Outcome of Image-Guided Small-Bore Catheter Drainage. Cardiovasc Intervent Radiol 31, 135–141 (2008). https://doi.org/10.1007/s00270-007-9197-0

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  • DOI: https://doi.org/10.1007/s00270-007-9197-0

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