Utilidade da ultra-sonografia no manejo do derrame pleural parapneumônico em crianças
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Data
2005
Autores
Pinotti, Karin Franco [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A radiografia simples de tórax (RX) é um exame já consagrado, no derrame pleural parapneumônico (DPP), mas através dela não é possível determinar a viscosidade do líquido, presença de loculações ou encarceramento pulmonar, que podem ser avaliados pela ultrassonografia torácica (US). Avaliar prospectivamente a utilidade da US feita antes da drenagem em crianças internadas com DPP. Todas as crianças internadas com diagnóstico de DPP após RX deveriam passar pela US onde eram avaliadas: loculação pleural, ecogenicidade e quantidade de líquido estimada. Após punção era avaliado o aspecto, pH e bioquímicos do líquido pleural. Nos drenados era aferido o volume do líquido drenado para comparação com o volume estimado pela US. Os pacientes sem melhora clínica ou radiológica após drenagem eram encaminhados para procedimento cirúrgico maior. De agosto de 2001 a julho de 2003 foram avaliadas 52 crianças (31?, 21?) com idade de 5 meses a 13 anos, predominando a faixa etária menor que 2 anos. Destas, foi realizada US em 48, das quais 35 foram drenadas e 13 tratadas clinicamente. Dois dos drenados necessitaram de cirurgia maior. A US mostrou derrame livre em 38 e loculado em 10 casos. Dos livres foram drenados 25 (65,8%) e dos loculados 10 (100%). Quanto à ecogenicidade13 eram anecóicos, 18 espessos com septações e 17 espessos sem septações; foram drenados 6 anecóicos (46,15%), 15 espessos com septação (83,33%) e 14 espessos sem septação (82,35%). O volume de líquido estimado pela US variou de 20 a 860 ml. Quanto à ecogenicidade, o volume do líquido foi significativamente maior nos espessos com septação, e quanto à loculação foi significativamente maior nos loculados. Não houve diferença significante nos bioquímicos quando os grupos foram separados pela ecogenicidade, mas o pH e glicose pleurais foram significantemente menores e o DHL significativamente...
Utility of thoracic ultrasound in the management of parapneumonic effusions in children. Thoracic radiography, a well-known procedure in parapneumonic effusion (PPE), cannot evaluate fluid viscosity, the presence of loculations or trapped lung, all of which can be established by thoracic ultrasound (US). Prospectively evaluate the utility of US before pleural drainage in children with PPE. All children hospitalized for PPE, identified by thoracic radiography, underwent US to assess pleural loculation, echogenicity, and amount of pleural fluid. After thoracocentesis, the extracted fluid was examined for gross appearance and was submitted to biochemical analysis. Among patients who underwent pleural drainage, the amount of fluid obtained from the procedure was compared to the amount estimated by US. Patients without clinical or radiological improvement underwent a more significant surgical procedure. From August 2001 to July 2003, 52 children (31 male, 21 female) were examined. These children ranged in age from 5 months to 13 years with the majority under the age of two. An US was performed on 48 of these children, 35 of whom received chest tube drainage and 13 of whom only received clinical treatment. Two pleural drainage patients, required a more significant surgical procedure. US identified 38 patients with free-flowing pleural fluid and 10 with loculated pleural fluid. Twenty five of the patients (65.8%) with free-flowing pleural fluid and 10 (100%) with loculation received chest tube drainage. Among patients with echogenicity, 13 were anechoic, 17 echoic without septations and 18 echoic with septations; 6 anaechoic (46.15%), 14 echoic without septations (82.35%) and 15 echoic with septations (83.33%) required chest tube drainage. The amount of fluid estimated by US varied from 20 to 860 ml. The volume of fluid was higher among patients that were echoic with... (Complete abstract click electronic access below)
Utility of thoracic ultrasound in the management of parapneumonic effusions in children. Thoracic radiography, a well-known procedure in parapneumonic effusion (PPE), cannot evaluate fluid viscosity, the presence of loculations or trapped lung, all of which can be established by thoracic ultrasound (US). Prospectively evaluate the utility of US before pleural drainage in children with PPE. All children hospitalized for PPE, identified by thoracic radiography, underwent US to assess pleural loculation, echogenicity, and amount of pleural fluid. After thoracocentesis, the extracted fluid was examined for gross appearance and was submitted to biochemical analysis. Among patients who underwent pleural drainage, the amount of fluid obtained from the procedure was compared to the amount estimated by US. Patients without clinical or radiological improvement underwent a more significant surgical procedure. From August 2001 to July 2003, 52 children (31 male, 21 female) were examined. These children ranged in age from 5 months to 13 years with the majority under the age of two. An US was performed on 48 of these children, 35 of whom received chest tube drainage and 13 of whom only received clinical treatment. Two pleural drainage patients, required a more significant surgical procedure. US identified 38 patients with free-flowing pleural fluid and 10 with loculated pleural fluid. Twenty five of the patients (65.8%) with free-flowing pleural fluid and 10 (100%) with loculation received chest tube drainage. Among patients with echogenicity, 13 were anechoic, 17 echoic without septations and 18 echoic with septations; 6 anaechoic (46.15%), 14 echoic without septations (82.35%) and 15 echoic with septations (83.33%) required chest tube drainage. The amount of fluid estimated by US varied from 20 to 860 ml. The volume of fluid was higher among patients that were echoic with... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Doenças respiratorias infantis, Pulmões - Doenças, Pulmões - Ultra-sonografia, Derrame pleura, Pneumonia, Empiema, Empyema
Como citar
PINOTTI, Karin Franco. Utilidade da ultra-sonografia no manejo do derrame pleural parapneumônico em crianças. 2005. 48 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2005.