My brother has been admitted with massive left sided primary spontaneous pneumothorax which was properly managed by us with chest tube drainage with full expansion of underlying lung. We went for chemical pleurodesis in the form of povidone iodine but what I found is that there was 450 ml collection in the chest drain bag in the next 24 hours and which became nearly 15 ml in the next 24 hours. My question is how can we explain this 450 ml collection after pleurodesis indicated for primary spontaneous pneumothorax?
Pleurodesis is effective by inducing a sterile pleuritis. This is frequently followed by a transient production of pleural fluid.
See: Rodriguez-Panadero et al, mechanisms of pleurodesis, Respiration, 2012; 83:91-98.
I-m agree with Dr. Van der Zee. Just make sure not previous symptomatology of previous tuberculosis symptoms have not been hided and he probably has both conditions.
But he had no symptoms, no fever, increased appetite, infact now resuming his daily activities....probably those fluids are just an exudates of increased permeability induced by pleurodesis induced pleuritis
Was it exudative fluid ?
We Do see a similar picture like what you have mentioned following pleurodesis. Transient and rapid resolution occur.
In addition to pleural inflammation, chest drain is a foreign body that stimulates the production of pleural fluid
It was an exudative fluid...resolution occurred in 2 days....do you have any literature references:?
Para mi no existen neumotórax primarios.Todos son secundarios a alguna patología pleuro-pulmonar. Serán espontáneos o de origen traumático entre los cuales están los yatrógenos.Si su hermano es joven y delgado lo mas posible es que tenga un neumotórax por rotura de bullas,generalmente en vértice pulmonar.Yo soy partidario de realizar su resección por VATS y pleurodesis en el vértice del hemitorax dejando un drenaje con aspiración. La pequeña pleurodesis la realizo por abrasión o con talco por spray, pero solo en la pleura de contacto con la resección. Hemos de pensar que si necesitase alguna vez un trasplante pulmonar lo haría muy dificil. A los dos dias se retira el drenaje.No dejan secuelas, si acaso discreta febrícula.Se asegura así que no habrán recidivas.
En el caso de realizar una pleurodesis química hay una pleuritis exudativa sobre todo si se deja demasido tiempo el drenaje. Hay que descartar que el neumotórax no tiene otra etiología .
Pleurodesis is an empirical technique made with utilization of talc or other chemical substances ( iodopovidone). It put in pleural space within drainage device for adhesion of visceral and parietal pleura. This technique produces heavy pain for highly sensitive of pleural space made of many sensorial and algic innervations. First choice before the V.A.T.S, its result is not warranted and it depends by pathology of the lung, because pneumothorax is rarely without a specific cause. For this reason is necessary a radiological examination: gold standard HRCT of the chest to know the state of the lungs , because probability of findings bullae are high.
iodopovodone is injected into the pleural cavity in small quantities compared to the saline solution, or chemical irritation would be very violent. For this reason, you should ask your surgeon how much the thoracic component of total substance injected into the pleural cavity. The lymph then 48 h after playing its role leading to a significant reduction in the content endopleural.
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