No abstract available.
Ascites ; Hydrops Fetalis* ; Pleural Effusion ; Ultrasonography

Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments. This review article provides information on the diagnostic approaches of pleural effusions and further suggested ways to confirm their various etiologies, by using the most recent journals for references.
Diagnosis ; Humans ; Korea ; Pleural Cavity ; Pleural Diseases ; Pleural Effusion* ; Pleurisy ; Radiography ; Rare Diseases ; Thorax ; Ultrasonography

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.
Catheters ; Chest Tubes* ; Drainage* ; Gravitation ; Hemothorax ; Humans ; Palliative Care ; Pleura ; Pleural Cavity ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurodesis ; Pneumothorax ; Pulmonary Edema ; Suction ; Surgical Instruments ; Thorax* ; Ultrasonography ; Vacuum

We experienced a case of congenital tuberculosis infected in utero, who had been found to have massive ascites and pleural effusion on routine ultrasonography at the 39 weeks' gestation. The emergency C-section delivered a male neonate weighing 2,050 g with poor condition and in severe respiratory distress. He was the first child born of a 27-year-old woman, who was diagnosed as having tuberculous pleurisy after delivery. Detection of acidfast bacilli in gastric aspirates obtained from the newborn as well as the clinical features and maternal history confirmed the diagnosis of congenital tuberculosis. Though rare, congenital tuberculosis requires early detection and treatment because of its severity and high mortality. A brief review of the relevant literature was made.
Adult ; Ascites* ; Child ; Diagnosis ; Emergencies ; Female ; Humans ; Infant, Newborn ; Male ; Mortality ; Pleural Effusion* ; Pregnancy ; Tuberculosis* ; Tuberculosis, Pleural ; Ultrasonography

Congenital chylothorax is a rare disorder and can be diagnosed by prenatal ultrasonography recently. Most cases of congenital chylothorax were characterized by different clinical courses of respiratory distress. We describe two female cases with congenital chylothorax observed by ultra- sonography prenatally. In the first case, left-sided pleural effusion was noted by prenatal ultrasonography taken at 34 weeks of gestation, and then pleural fluid was extracted by intrauterine thoracentesis under sonography guidance. After birth, this patient was managed by TPN(total parentral nutrition) and intermittent thoracentesis without surgical treatment. But, pleural fluid was accumulated recurrently and respiratory distress was aggravated. At 15th hospital day, shock state was developed and patient died. In the second case, bilateral pleural effusion and ascites were noted by prenatal ultrasonography, and then patient was delivered immediately without intrauterine thoracentesis. After birth, the second case received conservative therapy including mechanical ventilation, TPN, intermittent thoracentesis and paracentesis. The patient was discharged with complete regression of chylothorax. We report the two cases with brief review of related literatures.
Ascites ; Chylothorax* ; Female ; Humans ; Paracentesis ; Parturition ; Pleural Effusion ; Pregnancy ; Respiration, Artificial ; Shock ; Ultrasonography, Prenatal*

PURPOSE: To evaluate the utility of ultrasonograpy(US) as a guide in deciding drainage methods and as a prognostic factor in the prediction of pleural fibrosis, and to compare the effects of drainage methods in patients with tuberculous pleural effusions. MATERIALS AND METHODS: In 51 patients with tuberculous pleural effusion, US patterns of pleural effusion were classified according to degree of septa into three groups, into three groups, as follows: anechoic (n=5), linear septa (n=15), and honeycombing septa (n=31). US-guided drainage methods, including thoracentesis (n=17), percutaneous catheter insertion (n=12), catheter insertion with urokinase instillation (n=22) were employed. Therapeutic effects were evaluated with follow-up chest radiographs after 3 and 6 months. RESULTS: Three months after the procedure, 43 of 51 effusions had drained effectively. US guided drainage failed in eight patients including two of six with linear septated effusion treated with thoracentesis, four of seven with honeycomb septated effusion treated with thoracentesis, and two of six with honeycombing septated effusion treated with catheter drainage. There was no drainage failure in patients with anechoic effusions and in patients with urokinase instillation. Late effects were assessed in 39 patients after 6 months. Follow-up radiographs available in 39 patients demonstrated pleural fibrosis with intercostal space narrowing in 7 patients with honeycomb septated effusion, 3 patients with linear septated effusion, and none of the patients with anechoic effusions. CONCLUSION: The pattern of septa seen on US could be a useful factor for determining drainage methods and predicting late results in tuberculous pleural effusion. Percutaneous catheter drainage with urokinase instillation was a good drainage modality for patients with septated pleural effusions. Pleural fibrosis is more frequently induced by septated pleural effusion than by anechoic pleural effusion.
Catheters ; Drainage* ; Fibrosis ; Follow-Up Studies ; Humans ; Pleural Effusion* ; Radiography, Thoracic ; Ultrasonography* ; Urokinase-Type Plasminogen Activator

BACKGROUND: Pleural fluid collections may pose a difficult therapeutic problem. Complete drainage of complicated effusions or empyemas and reexpansion of atelectatic lung are important in obtaining a satisfactory clinical outcome. The usual approach to the diagnosis and treatment of patients with pleural effusion and empyema has been with needle thoracentesis and chest tube drainage. With chest tube drainage, technical difficulties and failures may occur as a result of improper tube drainage, particularly when there is a loculation or multiple and inaccesible collections. Fluoroscopic or sonographic guidance facilitates the proper tube insertion and drainage. METHOD: Twenty eight patients were required for tube drainage due to pleural fluid collections between January 1994 to February 1996. The author compared the results of drainage under applying each different method between blind chest tube insertion and image guided catheter insertion. RESULTS: The conventional blind chest tube group comprised 14 patients; 6 empyema, 6 tuberculous effusion, and 2 parapneumonic effusion. The image guided catheter group of smaller french were composed of 14 patients; 2 empyema, 6 tuberculous effusion, 5 parapneumonic effusion, and 1 effusion of undetermined origin. Radiologic improvement with successful drainage was noticed in 79% with the blind chest tube group, whereas in 93% with the image guided catheter group. The complication with the latter method was unremarkable. CONCLUSION: Image guided catheter drainage was safe and highly successful in treating patients, not only with complicated effusion also with loculated empyema. Image guided catheter drainage offers an alternative in patients in whom closed drainage is required as the initial treatment.
Catheters* ; Chest Tubes ; Diagnosis ; Drainage* ; Empyema* ; Humans ; Lung ; Needles ; Pleural Effusion* ; Ultrasonography

Radiofrequency ablation, one of the most common locoregional therapies for unresectable hepatocellular carcinoma (HCC) in Korea, has become an excellent alternative to curative surgery with advantages of minimal invasiveness, favorable complications, and low morbidity. The therapeutic efficacy of radiofrequency ablation (RFA) has been shown to be comparable to that of surgical resection for early-stage HCC. Long-term outcomes for HCC after radiofrequency ablation reported in large series studies were an overall survival of 54 - 60.2% at 5 years and 27.3 - 33% at 10 years. Recent technical developments in radiofrequency ablation include more effective separable clustered electrodes, hydrodissection techniques such as artificial ascites or pleural effusion, ultrasound - magnetic resonanace image fusion guidance, Sonazoid-enhanced ultrasonography guidance, and combined therapy with transarterial chemoembolization and sorafenib. In summary, radiofrequency ablation plays a key role in nonsurgical therapy and multidisciplinary approaches that aim to increase the survival rate of patients of hepatocellular carcinoma.
Ascites ; Carcinoma, Hepatocellular* ; Catheter Ablation* ; Electrodes ; Humans ; Korea ; Pleural Effusion ; Survival Rate ; Ultrasonography

The isolated fetal pleural effusion is rare and has no other signs of fetal hydrops. Its etiology is unknown but the most common cause is congenital chylothorax. We experienced a case of fetal pleural effusion diagnosed in the 35 weeks gestational age by antenatal ultrasonogram and antenatal diagnosis allowed early therapeutic intervention such as drainage of pleural fluid immediatly after birth. We diagnosed congenital chylothorax after neonate feeding changes the quality of pleural fluid from serous to milky So We report with a brief review and its related literatures.
Chylothorax ; Drainage ; Gestational Age ; Humans ; Hydrops Fetalis ; Infant, Newborn ; Parturition ; Pleural Effusion* ; Prenatal Diagnosis ; Ultrasonography

OBJECTIVE: To evaluate the technical feasibility of four-dimensional (4D) CT for the functional evaluation of the pediatric diaphragm. MATERIALS AND METHODS: In 22 consecutive children (median age 3.5 months, age range 3 days–3 years), 4D CT was performed to assess diaphragm motion. Diaphragm abnormalities were qualitatively evaluated and diaphragm motion was quantitatively measured on 4D CT. Lung density changes between peak inspiration and expiration were measured in the basal lung parenchyma. The diaphragm motions and lung density changes measured on 4D CT were compared between various diaphragm conditions. In 11 of the 22 children, chest sonography was available for comparison. RESULTS: Four-dimensional CT demonstrated normal diaphragm (n = 8), paralysis (n = 10), eventration (n = 3), and diffusely decreased motion (n = 1). Chest sonography demonstrated normal diaphragm (n = 2), paralysis (n = 6), eventration (n = 2), and right pleural effusion (n = 1). The sonographic findings were concordant with the 4D CT findings in 90.9% (10/11) of the patients. In diaphragm paralysis, the affected diaphragm motion was significantly decreased compared with the contralateral normal diaphragm motion (−1.1 ± 2.2 mm vs. 7.6 ± 3.8 mm, p = 0.005). The normal diaphragms showed significantly greater motion than the paralyzed diaphragms (4.5 ± 2.1 mm vs. −1.1 ± 2.2 mm, p < 0.0001), while the normal diaphragm motion was significantly smaller than the motion of the contralateral normal diaphragm in paralysis (4.5 ± 2.1 mm vs. 7.6 ± 3.8 mm, p = 0.01). Basal lung density change of the affected side was significantly smaller than that of the contralateral side in diaphragm paralysis (89 ± 73 Hounsfield units [HU] vs. 180 ± 71 HU, p = 0.03), while no significant differences were found between the normal diaphragms and the paralyzed diaphragms (136 ± 66 HU vs. 89 ± 73 HU, p = 0.1) or between the normal diaphragms and the contralateral normal diaphragms in paralysis (136 ± 66 HU vs. 180 ± 71 HU, p = 0.1). CONCLUSION: The functional evaluation of the pediatric diaphragm is feasible with 4D CT in select children.
Child ; Diaphragm ; Diaphragmatic Eventration ; Four-Dimensional Computed Tomography ; Humans ; Lung ; Paralysis ; Pleural Effusion ; Thorax ; Ultrasonography