Pleural Effusion

Pleural effusion is a condition where excess fluid accumulates between the layers of tissue that line the lungs and chest cavity, known as the pleura. This buildup of fluid can cause symptoms such as chest pain, coughing, and shortness of breath. Pleural effusion can result from various underlying conditions, including heart failure, infections, lung cancer, and pulmonary embolism.

Diagnosis typically involves imaging studies like chest X-rays, ultrasounds, or CT scans to detect the presence of fluid. Further testing, including thoracentesis (removal of fluid with a needle), may be conducted to analyze the fluid and determine the underlying cause.

Treatment of pleural effusion depends on the underlying cause and the severity of symptoms. It may include draining the fluid to relieve symptoms, treating the underlying medical condition, or using medications to prevent fluid re-accumulation. Early diagnosis and intervention are important to prevent complications and improve outcomes.

Intercostal Drainage Tube Placement (ICD) for Pleural Effusion

In cases where significant fluid buildup needs to be drained, an Intercostal Drainage Tube (ICD) may be used. The site of intercostal tube placement is first localised clinicoradiologically or with the help of USG if required. Antiseptic dressing and draping are done, and local anaesthesia is given in and around the area of ICD placement. A small incision is made in the skin, followed by intercostal muscle separation to reach the pleural space. Through this small hole in the chest, the tube is guided and introduced into the pleural space. The ICD is connected to an appropriate drainage bag. The chest tube is kept in place for the duration it is required, which varies amongst patients.

Possible Risks and Complications of ICD

The incidence of major and minor complications associated with ICD are 1.9% and 5.5%, respectively. The complications include improper placement, tube dislodgement, coughing, shoulder pain, prolonged air leak, hemorrhage, subcutaneous emphysema, postoperative fever, empyema, wound infection, cardiac arrhythmias, reexpansion pulmonary edema, hypotension, seeding of chest wall in patients with mesothelioma, diaphragmatic tear, and injury to surrounding organs. There may be a need for thoracotomy and additional procedures. The mortality rate associated with ICD performed is 0.09%.

Post-Procedure Course