Current Respiratory Medicine Reviews - Volume 8, Issue 4, 2012

Descending necrotizing mediastinitis is an acute, polymicrobial infection. Originating in the pharynx or neck, this necrotizing process descends into the chest producing widespread tissue necrosis. Despite the introduction of modern antimicrobial therapy and computed tomographic imaging, this form of mediastinitis has continued to produce reported mortality rates of 25% to 40%. This review discusses the pathophysiology, diag Read More

Hemothorax is most commonly seen following trauma or iatrogenic injury, but can be related to underlying medical issues. The primary issue to be determine dis whether or not the patient is stable and/or has ongoing hemorrhage. Simple tube thoracostomy usually suffices to manage the problem, but specific subsets of patients are at increased risk of complications, notably empyema. The role, type and timing of surgical i Read More

Formal resectional surgery for benign and malignant diseases of the lungs was one of the last frontiers to be explored and mastered within the broad specialty of surgery. This was the result of the unique physiological properties of the pleural space and the mechanics of respiration. Additional obstacles included the requirement for refined anesthesia, surgical techniques and equipment in order to allow successful co Read More

Prolonged air leak (PAL) is one of the most common complications after pulmonary resection. PAL is associated with longer hospital stay, increased morbidity, and increased cost. PAL can be defined in various ways, but the most commonly accepted definition is an air leak which prolongs the hospital stay. Patients with decreased lung function and emphysema are at the highest risk for PAL, as are patients with intrapleural adh Read More

The management of spontaneous pneumothorax in the non-ventilated patient is determined by whether or not there is marked underlying lung pathology (secondary) or not (primary). Primary pneumothorax is generally managed initially by simple tube drainage, although the success of operative approaches suggests that earlier intervention may be beneficial. In contrast, patients with severe underlying lung disease hav Read More

The management of empyema varies according to etiology and chronicity. Empyema most commonly arises in the setting of pneumonia. In general, early surgical drainage, using thoracoscopic approaches, are favored as they appear to be associated with quicker resolution and lower complication rates. However, anatomic and physiologic issues may affect outcomes and approaches, notably the presence or absence o Read More

Malignant pleural mesothelioma (MPM) is an aggressive malignancy. It most frequently develops following occupational exposure to asbestos, a highly flame-retardant material used in construction. The delay between exposure and development of MPM ranges from 25-50 years and therefore most patients present in the 5th to 7th decade of life. MPM can present like many other common pleural diseases therefore di Read More

Malignant pleural effusion represents advanced disease. Management is determined by the patient's performance status, symptoms and degree of lung re expansion after pleural fluid drainage. The goal of management is control of patient symptoms, with minimum morbidity and maximum patient independence. Pleural fluid evacuation and long term palliation can be achieved by either chemical pleurodesis or patient contro Read More

Chylothorax is a rare condition that results from thoracic duct damage with chyle leakage from the lymphatic system into the pleural space, usually on the right side. It first manifests as a pleural effusion, and although can have multiple causes, a chyle leak usually is a result of injury at the time of surgery. Definitive diagnosis involves cholesterol and triglyceride measurement in the pleural fluid. Complications include malnutrition Read More

Biological agents such as monoclonal antibodies, soluble receptors and molecular mimetics, offer the potential to enhance or replace conventional therapies in the treatment of autoimmune diseases, multiple sclerosis, solid tumors and hematological diseases. As tumor necrosis factor (TNF) plays an essential role in host defense, anti-TNF therapies have increased the risk of serious infections, including mycobacterial and opp Read More