PMC9563632_01
Purulent pleural fluid drained on day of presentation to pleural clinic.
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A left-sided thoracentesis was started but converted to a 14 Fr pigtail catheter placement due to aspiration of malodorous frank pus (Fig. 1).
A. Pleural adhesion seen on pleuroscopy. B. Pleura after adhesion takedown.
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The patient then underwent medical pleuroscopy with moderate sedation for a saline washout (Fig. 2), adhesion takedown and placement of tunneled pleural catheter (Pleurx, BD) 12 days after admission.
A-C Initial chest CT scan upon referral to our clinic, demonstrating intrapleural fluid collection with air-fluid level and pleural thickening. D-F Chest CT scan four-months after TPC placement demonstrating dramatic reduction in pleural collection.
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Four months following placement of the TPC she had no residual symptoms, her inflammatory markers (CRP, WBC) nadired, repeat CT chest showed dramatic improvement of her effusion with symphysis of her pleura (Fig. 3).
Chest radiograph just prior to TPC removal, five-months after initial placement, demonstrating small residual effusion.
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Chest radiograph demonstrated trace pleural effusion (Fig. 4) and the TPC was subsequently removed.
PMC9563632_02
A. Pleuroscopy demonstrating significant pleural adhesions. B. Take-down of pleural adhesions. C. Pleural space after removal of adhesions.
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Given re-accumulation, medical pleuroscopy under moderate sedation with TPC placement was performed (Fig. 5).
A-C: Chest CT scan on initial referral to our pleural clinic, demonstrating a large loculated effusion. D-F Chest CT scan four-months following tunneled pleural catheter placement demonstrating pleural symphysis. G-I Most recent chest CT scan available, 17-months following TPC placement, showing pleural symphysis with some associated rounded atelectasis.
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