Ultrasound and Intrapleural Enzymatic Therapy for Complicated Pleural Effusion: A Case Series with a Literature Review

被引:0
|
作者
Inchingolo, Riccardo [1 ]
Ielo, Simone [2 ]
Barone, Roberto [2 ]
Whalen, Matteo Bernard [2 ]
Carriera, Lorenzo [2 ]
Smargiassi, Andrea [1 ]
Sorino, Claudio [3 ]
Lococo, Filippo [4 ]
Feller-Kopman, David [5 ]
机构
[1] Fdn Policlin Univ A Gemelli IRCCS, Dipartimento Neurosci Organi Senso & Torace, UOC Pneumol, I-00168 Rome, Italy
[2] Univ Cattolica Sacro Cuore, Fac Med & Chirurg, I-00168 Rome, Italy
[3] Univ Insubria, St Anna Hosp Como, Div Pulmonol, I-21100 Varese, Italy
[4] Univ Cattolica Sacro Cuore, Fdn Policlin Univ Agostino Gemelli IRCCS, Thorac Surg, I-00168 Rome, Italy
[5] Dartmouth Hitchcock Med Ctr, Sect Pulm & Crit Care Med, Lebanon, NH 03766 USA
关键词
lung ultrasound; intrapleural enzymatic therapy; urokinase; alteplase; t-PA; DNase; complex pleural effusion; empyema; TISSUE-PLASMINOGEN ACTIVATOR; PARAPNEUMONIC EFFUSIONS; CONTROLLED-TRIAL; EMPYEMA; UROKINASE; STREPTOKINASE; MANAGEMENT; THORACOSCOPY; ALTEPLASE;
D O I
10.3390/jcm13154346
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Pleural effusion is the most common manifestation of pleural disease, and chest ultrasound is crucial for diagnostic workup and post-treatment monitoring. Ultrasound helps distinguish the various types of pleural effusion and enables the detection of typical manifestations of empyema, which presents as a complicated, septated effusion. This may benefit from drainage and the use of intrapleural enzyme therapy or may require more invasive approaches, such as medical or surgical thoracoscopy. The mechanism of action of intrapleural enzymatic therapy (IPET) is the activation of plasminogen to plasmin, which breaks down fibrin clots that form septa or the loculation of effusions and promotes their removal. In addition, IPET has anti-inflammatory properties and can modulate the immune response in the pleural space, resulting in reduced pleural inflammation and improved fluid reabsorption. In this article, we briefly review the literature on the efficacy of IPET and describe a case series in which most practical applications of IPET are demonstrated, i.e., as a curative treatment but also as an alternative, propaedeutic, or subsequent treatment to surgery.
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页数:18
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