Abstract
Objectives: Pleural effusions commonly occur in conjunction with acute pulmonary emboli (PE). There are no guidelines on the investigation and management of these effusions. We aimed to review local management to inform future practiceMaterial and Methods: This was a retrospective, observational single centre study, looking at all computed tomography pulmonary angiograms done in a large hospital in the North East of England in 2019. Electronic notes, imaging and discharge letters of patients with PE were reviewed. Statistical analysis was performed to describe patient-specific variables, clinical characteristics, pathological findings and subsequent management decisions. Results: 1630 computed tomography pulmonary angiographies (CTPAs) were requested to investigate for PE. Three hundred sixteen (19.4%) were positive for PE. Of those, 89 (28.1%) were identified as having associated pleural effusions. Five (5.8%) patients had a contemporaneous pleural aspiration. All pleural effusions were exudative. Four were consistent with known malignant diagnoses. The other patient had concurrent pneumonia and pancreatitis. Nineteen (21%) had no risk factors for effusion development. The presence of pulmonary infarction/consolidation was associated with the development of a pleural effusion.Conclusions: This project is a single centre review with the largest number of patients looking at pleural effusions associated with pulmonary emboli. Although pleural effusions commonly occur with PE and lung infarction, pleural aspiration is rarely performed. Management is not altered by the presence of an effusion.
Highlights
Pulmonary embolism (PE) has an incidence of 39-115 per 100,000 [1] with an estimated annual mortality rate of 8.3 per 100,000 [2]
This project is a single centre review with the largest number of patients looking at pleural effusions associated with pulmonary emboli
Stevenson at al. recently published a clear review of pulmonary embolism for the acute medicine department, and the review was directed toward risk stratification in the coronavirus disease 2019 (COVID-19) pandemic, it highlights the fact that PE is increasingly predominantly managed by acute medicine physicians [6]
Summary
Pulmonary embolism (PE) has an incidence of 39-115 per 100,000 [1] with an estimated annual mortality rate of 8.3 per 100,000 [2]. The introduction of ambulatory care units and the concept of Same Day Emergency Care (SDEC) in the UK has allowed the outpatient management of many conditions such as PE and has enabled, diagnosis, monitoring, and initiation of treatment over hours rather than days. This strategy was mentioned in the 2018 British Thoracic Society (BTS) guidelines [4]. Recently published a clear review of pulmonary embolism for the acute medicine department, and the review was directed toward risk stratification in the coronavirus disease 2019 (COVID-19) pandemic, it highlights the fact that PE is increasingly predominantly managed by acute medicine physicians [6]. A recent statement on the Society of Acute Medicine website is testament to this as well [7]
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