title: Emergencies in pleural diseases.
abstract: A parapneumonic effusion should be drained if it is large (≥ 1/2 of the hemithorax), loculated, frank pus is obtained, if the fluid is non-purulent fluid but has a low pH (< 7.20) or if the culture is positive. Instillation of fibrinolytics and DNase thorough the chest catheter in locutated effusions and empyemas is currently recommended. Management of spontaneous pneumothorax is fundamentally influenced by the patient's symptoms. Insertion of a chest catheter is mandatory if there is significant dyspnea, hemodynamic instability or large pneumothoraces (≥ 2 cm). Pleural ultrasonography confirms the presence of air or fluid in the pleural space and serves to guide any pleural procedure (e.g., thoracentesis, chest tubes). The use of small-bore 12F catheters inserted via the percutaneous Seldinger technique under ultrasonography guidance is a safe and effective procedure in complicated parapneumonic effusions/empyema and most pneumothoraces.
authors.affiliation: Unidad de Patología Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain. jporcelp@yahoo.es
authors.forename: J M
authors.initials: JM
authors.lastname: Porcel
authors.forename: D
authors.initials: D
authors.lastname: García-Gil
mesh_terms: D004322:Drainage / Q000295:instrumentation; D004638:Emergency Treatment; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000628:therapy; D011859:Radiography