This is a case of 77-year old male who was diagnosed with Hypertensive Cardiovascular Disease (HCVD), Chronic Kidney Disease and Adenocarcinonam of the prostrate. He was also diagnosed earlier this year with Coronary Artery Disease – 3-vessel disease and underwent coronary artery bypass graft in June 2010. He is also hemodialysis three times a week.
He was admitted for planned pleurodesis due to diagnosed pleural effusion of about 600-700 cc of fluid on each side of the pleural space, however patient was undecided. Since then, patient has gradual development of dyspnea or difficulty breathing.
His dypnea was relieved by thoracentesis. The surgeon then suggested for bilateral thoracoscopy for the evaluation of the pleural cavity and possible biopsy of questionable and doubtful fluids and talc pudrage. The talc pudrage of the pleural cavity is the administration of a talc to promote adhesion of tissues so as to prevent accumulation of fluid. During pleuroscopy talc is insufflated through the lumen of the mediastinoscope. Up to 2 gr of purified talc is sprinkled under vision over the entire pleural surface.
Source: www.ncbi.nlm.nih.gov
The procedure was successful and the patient was discharged 2 days after the chest tubes were removed. There were no complaints about dyspnea and he can tolerate room air. He will just come back as an out-patient for his hemodialysis.

Ms. S who was admitted due to interstitial lung disease has just undergone minithoracotomy was placed on mechanical ventilator due to deteriorating oxygenation in her body. The surgeon suspects pleural effusion or accumulation of fluid in the interstitial space in the lungs. They are considering pleurodesis. A procedure that causes the membranes around the lung to stick together and prevents the build up of fluid in the space between the membranes. This procedure is done in cases of severe recurrent pleural effusion (fluid around the lungs), as from cancer, to prevent the reaccumulation of fluid. The doctors want to rule out Mesothelioma also known as Malignant mesothelioma (Source: Medlineplus) According to National Cancer Institute, The tissue that lines your lungs, stomach, heart and other organs is called mesothelium. Mesothelioma is cancer of that tissue. It is a rare but serious type of cancer. It usually starts in the lungs, but can also start in the abdomen or other organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles. It can take a long time – 30 to 50 years – between being around asbestos and getting the disease. Treatment includes surgery, radiation, chemotherapy or all three.
I hope that pleurodesis will work for her.

Mrs. M, 86 year-pld, female, was admittted due to complaint of difficulty breathing associated with pulmonary tuberculosis. She has edema of the lower extremities and was diagnosed to have pleural effusion or accumulation fo fluid in the interstitial space sorrounding her lungs. She also had fluid in her lungs and pericardial effusion or lung accumulation in the pericardial space. She is was started on Furosemide diuretic via IV to help her evacuate excess fluid through urine. Also, her lab works show low red blood cell count that is why 2 packs of RBC was started. I was able to finish the first unit and endorsed the ongoing transfusion of the second pack.
Her attending made his rounds on her and informed her relatives that due to the patient’s age, they will do the conservative approach in draining the fluids off her lungs.
Blood pressure was stable at 150ss and she had her highest in my shft at 180.
I was able to endorse the patient in stable condition that it why I was surprised to learn that she expired early morning.
She had 80 palpatory BP and oxygen saturation was very poor that they had to conduct emergency Echocardiographically guided pericardiocentesis in the cardiac catheterization laboratory around 1:00 am. However, around 4:00 am the code was called because she was not able to recover. She expired.
According to medline plus online:

Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (the muscle of the heart) and the pericardium (the outer covering sac of the heart).
In this condition, blood or fluid collects within the pericardium. This prevents the ventricles from expanding fully. They cannot fill enough or pump blood.

Cardiac tamponade can occur due to:

* Dissecting aortic aneurysm (thoracic)
* End-stage lung cancer
* Heart attack (acute MI)
* Heart surgery
* Pericarditis caused by bacterial or viral infections
* Wounds to the heart

In Mrs M’s case, hers was caused by pericarditis