Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 28 (1), 75-86

Management of Pleural Effusion, Empyema, and Lung Abscess

Affiliations

Management of Pleural Effusion, Empyema, and Lung Abscess

Hyeon Yu. Semin Intervent Radiol.

Abstract

Pleural effusion is an accumulation of fluid in the pleural space that is classified as transudate or exudate according to its composition and underlying pathophysiology. Empyema is defined by purulent fluid collection in the pleural space, which is most commonly caused by pneumonia. A lung abscess, on the other hand, is a parenchymal necrosis with confined cavitation that results from a pulmonary infection. Pleural effusion, empyema, and lung abscess are commonly encountered clinical problems that increase mortality. These conditions have traditionally been managed by antibiotics or surgical placement of a large drainage tube. However, as the efficacy of minimally invasive interventional procedures has been well established, image-guided small percutaneous drainage tubes have been considered as the mainstay of treatment for patients with pleural fluid collections or a lung abscess. In this article, the technical aspects of image-guided interventions, indications, expected benefits, and complications are discussed and the published literature is reviewed.

Keywords: Pleural effusion; empyema; interventional radiology; lung abscess; malignant pleural effusion.

Figures

Figure 1
Figure 1
(A) An ultrasound image shows a multiloculated pleural effusion. (B) A guidewire (triple arrows) is inserted through the initial access needle into the pleural effusion for drainage catheter placement. (C) A chest radiograph shows a large amount of left-sided pleural effusion. (D) An axial computed tomography (CT) image shows large amount of pleural effusion with a 10F pigtail catheter placed percutaneously under CT guidance. The posterior part of the effusion is removed and replaced with air.
Figure 2
Figure 2
(A) An axial computed tomography (CT) image shows a complicated pleural effusion with inner septations and adjacent atelectatic lung parenchyma. (B) A 10F nontunneled pigtail catheter is placed percutaneously under CT guidance. (C) A chest radiograph shows a complete opacification in the left hemothorax due to pleural effusion. (D) Follow-up chest radiograph after placement of pigtail drainage catheter shows decreased effusion with reexpanded lung parenchyma.
Figure 3
Figure 3
(A) Complete Pleurx® kit showing Pleurx® catheter with a metal tunneler, guidewire, peel-away sheath, dilators, access needle, connecting tube, and cap. (B) Drainage bottle with connector. The end of the connecting tube fits in the one-way valve at the hub of the Pleurx® catheter.
Figure 4
Figure 4
(A) Posteroanterior chest radiograph shows a 7-cm lung abscess with an air-fluid level in the right middle lobe. (B) An axial computed tomography (CT) image shows an abscess with an irregular outer margin and inner air-fluid level. (C) An axial CT image shows a 10F nontunneled pigtail drainage catheter placed percutaneously in the lung abscess. (D) Follow-up chest radiograph shows a pigtail catheter in the abscess with decreased size without an air-fluid level.

Similar articles

See all similar articles

Cited by 14 PubMed Central articles

See all "Cited by" articles
Feedback