CHEST Guidelines-A-Patient-With-Effusion-Undergoing-Pleural Bi

A-Patient-With-Effusion-Undergoing-Pleural Bi

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The document reports a case of a 59-year-old woman who presented with acute right-sided chest pain, dry cough, and dyspnea. Her blood work showed leukocytosis with neutrophil predominance, and elevated D-dimer levels. A CT pulmonary angiography ruled out pulmonary embolism but identified a right-sided partially encysted pleural effusion with pleural thickening and bilateral lung consolidations. Pleural fluid analysis suggested an exudate type effusion, but bacterial cultures were negative, increasing suspicion for pleuropulmonary tuberculosis.<br /><br />Due to inconclusive test results, an ultrasound-guided pleural biopsy was performed. Issues arose when the post-biopsy ultrasound showed signs suggestive of bleeding from the parietal pleura. Doppler examination confirmed pleural bleeding. Immediate action with external compression stopped the bleeding, while a thrombus was noted at the site, likely supported by the fine septations in the pleural fluid.<br /><br />The document discusses the safety and efficacy of ultrasound-guided pleural biopsy, particularly in diagnosing pleural disease when thoracoscopy is not feasible. Proper antiseptic technique, thorough pre-procedural assessment, and real-time ultrasound guidance are emphasized to mitigate risks such as intrapleural bleeding. The paper explains that ultrasound examination is crucial for safe pleural procedures and identifying potentially vulnerable intercostal arteries. Although bleeding can be life-threatening due to the pleural cavity's capacity to accommodate large fluid volumes, timely ultrasound identification aids in effective management.<br /><br />The report highlights the practice's effectiveness and safety, underscoring the importance of careful planning and the use of Doppler technology to minimize complications in pleural biopsies. It also mentions that pleural bleeding, though rare, requires prompt and effective intervention to prevent severe outcomes.

Keywords

pleural effusion

ultrasound-guided biopsy

pleuropulmonary tuberculosis

pleural bleeding

Doppler examination

pleural disease diagnosis

intrapleural bleeding risk

thoracoscopy alternative

intercostal arteries

pleural fluid analysis