The Relationship of Pleural Manometry With Postthoracentesis Chest Radiographic Findings in Malignant Pleural Effusion.
Chopra A., Judson MA., Doelken P., Maldonado F., Rahman NM., Huggins JT.
<h4>Background</h4>Both elevated pleural elastance (E-P<sub>EL</sub>) and radiographic evidence of incomplete lung expansion following thoracentesis have been used to exclude patients with a malignant pleural effusion (MPE) from undergoing pleurodesis. This article reports on a cohort of patients with MPE in whom complete drainage was attempted with pleural manometry to determine the frequency of E-P<sub>EL</sub> and its relation with postthoracentesis radiographic findings.<h4>Methods</h4>Seventy consecutive patients with MPE who underwent therapeutic pleural drainage with pleural manometry were identified. The pressure/volume curves were constructed and analyzed to determine the frequency of E-P<sub>EL</sub> and the relation of P<sub>EL</sub> to the postthoracentesis chest radiographic findings.<h4>Results</h4>E-P<sub>EL</sub> and incomplete lung expansion were identified in 36 of 70 (51.4%) and 38 of 70 (54%) patients, respectively. Patients with normal P<sub>EL</sub> had an OR of 6.3 of having complete lung expansion compared with those with E-P<sub>EL</sub> (P = .0006). However, 20 of 70 (29%) patients exhibited discordance between postprocedural chest radiographic findings and the pleural manometry results. Among patients who achieved complete lung expansion on the postdrainage chest radiograph, 9 of 32 (28%) had an E-P<sub>EL</sub>. In addition, P<sub>EL</sub> was normal in 11 of 38 (34%) patients who had incomplete lung expansion as detected according to the postthoracentesis chest radiograph.<h4>Conclusions</h4>E-P<sub>EL</sub> and incomplete lung expansion postthoracentesis are frequently observed in patients with MPE. Nearly one-third of the cohort exhibited discordance between the postprocedural chest radiographic findings and pleural manometry results. These findings suggest that a prospective randomized trial should be performed to compare both modalities (chest radiograph and pleural manometry) in predicting pleurodesis outcome.