Key result
A systematic approach using ultrasonography and appropriate invasive procedures facilitates rapid diagnosis and definitive management of urgent pleural effusions in the emergency department.
Why the study?
In patients admitted to the emergency department for acute chest pain and dyspnea requiring urgent treatment, rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving.
This review provides a systematic approach for emergency physicians to rapidly diagnose and manage pleural effusions using ultrasonography and appropriate drainage procedures.
May support ultrasound integration in ED pleural effusion protocols; leaves open need for prospective validation.
BACKGROUND: In symptomatic patients, admitted in emergency department for acute chest pain and dyspnea, who require an urgent treatment, a rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving. AIM: The aim of this review was to summarize the current diagnostic and therapeutic approaches for the management of the main types of pleural effusions that physicians can have in an emergency department setting. METHODS: Current literature about the topic was reviewed and critically reported, adding the experience of the authors in the management of pleural effusions in emergency settings. RESULTS: The paper analyzed the main types of pleural effusions that physicians can have to treat. It illustrated the diagnostic steps by the principal radiological instruments, with a particular emphasis to the role of ultrasonography, in facilitating diagnosis and guiding invasive procedures. Then, the principal procedures, like thoracentesis and insertion of small and large bore chest drains, are indicated and illustrated according to the characteristics and the amount of the effusion and patient clinical conditions. CONCLUSION: The emergency physician must have a systematic approach that allows rapid recognition, clinical cause identification and definitive management of potential urgent pleural effusions.
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Congedo et al. (2020) conducted a review in Pleural effusions. Diagnostic and therapeutic approaches (ultrasonography, thoracentesis, chest drains) was evaluated. A systematic approach using ultrasonography and appropriate invasive procedures facilitates rapid diagnosis and definitive management of urgent pleural effusions in the emergency department.
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