Chest
Original ResearchCharacteristics of Trapped Lung: Pleural Fluid Analysis, Manometry, and Air-Contrast Chest CT
Section snippets
Materials and Methods
We performed a retrospective review of 247 consecutive patients referred for therapeutic thoracentesis in our database at the Medical University of South Carolina between October 2002 and November 2005. We identified 11 patients in whom a diagnostic pneumothorax was performed in accordance with the clinical protocol that we established in 2001.
The clinical protocol we use routinely during pleural manometry requires a diagnostic pneumothorax to be performed when all of the following criteria are
Results
Eleven patients with a clinical diagnosis of trapped lung were identified in this series. The causes of trapped lung were attributed to coronary artery bypass graft surgery (CABG) in four patients, uremia in three patients, thoracic radiation in one patient, spontaneous bacterial pleuritis and multiple thoracenteses in one patient, pericardiotomy in one patient, and complicated parapneumonic effusion in one patient. Mean pleural fluid pH was 7.37 (range, 7.26 to 7.46). Mean pleural fluid
Background
At our pleural disease service, we are frequently asked to evaluate patients with chronic, persistent pleural effusions that have defied diagnosis and have undergone multiple thoracenteses. In our database, there were patients in whom a diagnostic pneumothorax was induced that provided a confident clinical diagnosis of trapped lung. The detection of a trapped lung was a direct consequence of the clinical protocol we introduced in 2001 that was designed for the evaluation of pleural effusion.
Conclusions
Trapped lung represents the end stage of dysfunctional healing of pleural injury that begins as a form of lung entrapment that results in the formation of a visceral pleural peel and a persistent pleural effusion. Trapped lung should be included in the differential diagnosis of patients with a remote pleural injury and in whom a chronic, radiographically stable pleural effusion without obvious cause is encountered. A high index of suspicion must be maintained in order to avoid repeated
References (13)
- et al.
Pleural manometry: technique and clinical implications
Chest
(2004) - et al.
Pathophysiology of pneumothorax following ultrasound-guided thoracentesis
Chest
(2006) - et al.
The spectrum of pleural effusions following CABG surgery
Clin Chest Med
(2006) - et al.
The trapped lung with chronic pleural space: a cause of recurring pleural effusion
Mil Med
(1967) - et al.
Trapped lung
Semin Respir Crit Care Med
(2001) The Pleura
Am Rev Respir Dis
(1988)
Cited by (85)
Update on pleural effusion
2022, Medicine (Spain)Predictors of lung entrapment in malignant pleural effusion
2022, PulmonologyMalignant Pleural Effusions
2021, Clinics in Chest MedicineAnatomy and Applied Physiology of the Pleural Space
2021, Clinics in Chest MedicineAvoid the Trap: Nonexpanding Lung
2021, Chest
None of the authors have any conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml).