Riker David, Sell Rebecca
Department of Medicine, Division of Pulmonary and Critical Care Medicine, San Diego Medical Center, University of California-San Diego, CA, USA.
J Bronchology Interv Pulmonol. 2012 Apr;19(2):165-7. doi: 10.1097/LBR.0b013e3182517bba.
Malignant pleural effusion is a common cause of morbidity and mortality in patients suffering from end-stage metastatic cancer. Malignant pleural effusion is associated with a shortened survival of 3 to 12 months after diagnosis, with 1- and 6-month mortality rates of 54% and 85%, respectively. Nearly all medical management in these patients is directed toward palliation of symptoms caused by pleural fluid accumulation. Options for treatment are repeated thoracentesis, use of chronic indwelling catheters, pleurodesis, and pleuroperitoneal shunts. Associated procedure risks include infection, bleeding, pneumothorax, and respiratory failure. Transthoracic ultrasound use is advocated to minimize procedural risks for thoracentesis and indwelling pleural catheter (IPC) placement. Most patients with advanced metastatic cancer and pleural effusion are not suitable candidates for pleuroscopy-delivered pleurodesis. Therefore, IPC is more commonly chosen to palliate respiratory symptoms related to pleural fluid accumulation from pleural tumor burden. Although pleural catheter complications are low, malignant seeding of the pleural tract can occur. Transthoracic ultrasound use to determine the presence of pleural tract seeding in conjunction with guided percutaneous biopsy has not been described. We report the use of ultrasound-guided percutaneous biopsy to diagnose metastatic seeding of an IPC.
恶性胸腔积液是终末期转移性癌症患者发病和死亡的常见原因。恶性胸腔积液与诊断后3至12个月的生存期缩短相关，1个月和6个月的死亡率分别为54%和85%。这些患者几乎所有的医疗管理都旨在缓解由胸腔积液积聚引起的症状。治疗选择包括反复胸腔穿刺、使用慢性留置导管、胸膜固定术和胸腹膜分流术。相关的手术风险包括感染、出血、气胸和呼吸衰竭。提倡使用经胸超声以尽量减少胸腔穿刺和留置胸腔导管（IPC）放置的手术风险。大多数晚期转移性癌症和胸腔积液患者不适合接受胸腔镜下胸膜固定术。因此，IPC更常用于缓解与胸膜肿瘤负荷导致的胸腔积液积聚相关的呼吸症状。虽然胸膜导管并发症发生率较低，但可发生胸膜通道的恶性种植。尚未描述结合超声引导经皮活检来确定胸膜通道种植的情况。我们报告了使用超声引导经皮活检来诊断IPC的转移性种植。
