Advertisement

IR Playbook pp 463-475 | Cite as

Ascites and Pleural Effusion

  • Katherine Sterner
  • Arun Krishnaraj
Chapter

Abstract

When an underlying derangement in fluid balance occurs, fluid will accumulate in potential spaces including the thoracic cavity and abdominal cavity. These fluid collections are referred to as a pleural effusion in the pleural space or ascites in the peritoneal cavity. Mechanisms underlying pleural effusion and ascites include abnormalities in hydrostatic pressure, oncotic pressure, vascular permeability, or lymphatics. Treatment is aimed at the underlying etiology. Depending on the clinical scenario, a diagnostic fluid sample may be necessary to determine the cause of an abnormal fluid collection. Percutaneous image-guided procedures, such as thoracentesis for drainage of pleural fluid or paracentesis for drainage of ascites, are safe and effective techniques to obtain fluid for diagnostic purposes and have become standard of care. In cases where fluid reaccumulates, these procedures can be performed for symptomatic relief. Image-guided thoracentesis and paracentesis are more cost-effective and result in lower morbidity and mortality compared to non-image-guided invasive alternate diagnostic techniques.

Keywords

Ascites Pleural effusion Empyema Paracentesis Thoracentesis Thoracostomy tube Tunneled pleural catheter 

References

  1. 1.
    Kumar V, Abbas AK, Fausto N, Aster JC. Pathologic basis of disease. 8th ed. Philadelphia: Saunders; 2010.Google Scholar
  2. 2.
    Runyon BA. Management of adult patients with ascites due to cirrhosis: update 2012. Hepatology. 57(4), 2013:1–26.Google Scholar
  3. 3.
    Kuiper JJ, van Buuran HR. Ascites in cirrhosis: a review of management and complications. Netherlands. J Med. 2007;65(8):283–8.Google Scholar
  4. 4.
    Pedersen JS, Bendtsen F, Moller S. Management of cirrhotic ascites. Ther Adv Chronic Dis. 2015;6(3):124–37.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Thomsen TW, Shaffer RW, White B, Setnik GS. Paracentesis. N Engl J Med. 2006;355(19):e21.CrossRefPubMedGoogle Scholar
  6. 6.
    McGibbon A, Chen GI, Peltekain KM, Veldhuyzen van Zanten S. An evidence-based manual for abdominal paracentesis. Dig Dis Sci. 2007;52:3307–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Froudarakis ME. Diagnostic work-up of pleural effusion. Respiration. 2008;75:4–13.CrossRefPubMedGoogle Scholar
  8. 8.
    McGrath EE, Anderson PB. Diagnosis of pleural effusion: a systematic approach. Am J Crit Care. 2011;20(2):119–27.CrossRefPubMedGoogle Scholar
  9. 9.
    Medford A, Maskell N. Pleural effusion. Postgrad Med J. 2005;81:702–10.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. OAEM. 2012;4:31–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Webb WR. The pleura and pleural disease. In: Webb WR, Higgins CB, editors. Thoracic imaging. 3rd ed. Philadelphia: Wolters Kluwer; 2017. p. 660–98.Google Scholar
  12. 12.
    Gore RM, Silvers RI, Newmark GM, Gore MD. Ascites and peritoneal fluid collections. In: Gore RM, Levine MS, editors. Textbook of gastrointestinal radiology. 4th ed. Philadelphia: Elsevier; 2015. p. 2024–35.Google Scholar
  13. 13.
    Thoeni RF. The role of imaging in patients with ascites. AJR. 1995;165:16–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Bard C, Lafortune M, Breton G. Ascites: ultrasound guidance or blind paracentesis. CMAJ. 1986;135:209–10.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Hanbidge AE, Lynch D, Wilson SR. US of the peritoneum. Radiographics. 2003;23:663–85.CrossRefPubMedGoogle Scholar
  16. 16.
    Management YH. Of pleural effusion, empyema and lung abscess. Semin Intervent Radiol. 2011;28(1):75–86.CrossRefGoogle Scholar
  17. 17.
    Soni NJ, Franco R, Velez MI, Schnobrich D, Dancel R, Restrepo MI, et al. Ultrasound in the diagnosis and management of pleural effusions. J Hosp Med. 2015;10(12):811–6.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Pericleous M, Sarnowski A, Moore A, Fijten R, Zaman M. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations. Eur J Gastroenterol Hepatol. 2016;28(3):10–8.CrossRefGoogle Scholar
  19. 19.
    Orman ES, Hayashi PH, Bataller R, Barritt AS. Paracentesis is associated with reduced mortality in patients hospitalized with cirrhosis and ascites. Clin Gastroenterol Hepatol. 2014;12(3):496–503.CrossRefPubMedGoogle Scholar
  20. 20.
    Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23:727–36.CrossRefPubMedGoogle Scholar
  21. 21.
    O’Connor SD, Taylor AJ, Williams EC, Winter TC. Coagulation concepts update. AJR. 2009;193:1656–64.CrossRefPubMedGoogle Scholar
  22. 22.
    Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB. Clinical outcomes after bedside and interventional radiology paracentesis procedures. Am J Med. 2013;126(4):349–56.CrossRefPubMedGoogle Scholar
  23. 23.
    Sola-Vera J, Minana J, Ricart E, Planella M, Gonzalex B, Torras X, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology. 2003;37(5):1147–53.CrossRefPubMedGoogle Scholar
  24. 24.
    Kwok CS, Krupa L, Mahtani A, Kaye D, Rushbrook SM, Phillips MG, et al. Albumin reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment among patients with cirrhosis and infection: a systematic review and meta-analysis. Biomed Res Int. 2013;2013:1–8.Google Scholar
  25. 25.
    Lewandowski RJ, Desai SB, Nemcek AA. Treatment of effusions and abscesses. In: Mauro MA, Murphy KPJ, Thomson KR, Venbrux AC, Zollikofer CL, editors. Image-guided interventions, vol. 1. Philadelphia: Saunders; 2008. p. 1615–27.Google Scholar
  26. 26.
    Hogg JR, Caccavale M, Gillen B, McKenzie G, Vlaminck J, Fleming CJ, et al. Tube thoracostomy: a review for the interventional radiologist. Semin Intervent Radiol. 2011;28(1):39–47.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Patz EF, Erasmus JJ. Catheter drainage of intrathoracic collections. In: Kandarpa K, Aruny JE, editors. Handbook of interventional radiologic procedures. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 154–62.Google Scholar
  28. 28.
    McDermott S, Levis DA, Arellano RS. Chest drainage. Semin Intervent Radiol. 2012;29(4):247–55.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Jones PW, Moyers P, Rogers JT, Rodriguez RM, Lee CG, Light RW. Ultrasound thoracentesis. Chest. 2003;123(2):418–23.CrossRefPubMedGoogle Scholar
  30. 30.
    Thomsen TW, DeLaPena J, Setnnik GS. Thoracentesis. N Engl J Med. 2006;355(15):e16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Virginia Health System, Department of Radiology and Medical ImagingCharlottesvilleUSA
  2. 2.Division of Body Imaging, UVA School of Medicine, University of Virginia Health System, Department of Radiology and Medical ImagingCharlottesvilleUSA

Personalised recommendations