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Management of pleural effusions in children with malignant lymphoma
J B Pietsch1, J A Whitlock, C Ford
1Department of Pediatric Surgery, Vanderbilt Children's Hospital, Nashville, TN, USA.
Insights
Pediatric malignant pleural effusions, often linked to non-Hodgkin
Area of Science:
- Pediatric Oncology
- Thoracic Medicine
- Diagnostic Procedures
Background:
- Malignant pleural effusions are a significant complication in children with lymphoma.
- Diagnosis and management can be challenging, requiring specialized approaches.
Observation:
- Six pediatric cases of malignant lymphoma with pleural effusions were reviewed.
- Symptoms often mimic pneumonia; large mediastinal masses can exacerbate respiratory distress.
- Thoracentesis via Seldinger technique proved effective for diagnosis and initial fluid management.
Findings:
- Pleural fluid analysis yielded a lymphoma diagnosis in 5 of 6 children.
- Complications included reexpansion pulmonary edema (2 cases) and empyema (1 case).
- Pleural fluid reaccumulation was common prior to chemotherapy initiation.
Implications:
- Thoracentesis is the recommended initial diagnostic and therapeutic step for pediatric malignant pleural effusions.
- Careful fluid removal is crucial to prevent complications like reexpansion pulmonary edema.
- Prompt chemotherapy is essential following fluid management.
Purpose:
The aim of this study was to determine potential problems in the diagnosis and management of children with pleural effusions and malignant lymphoma as well as the efficacy of thoracentesis.
Methods:
The case histories of six children with malignant lymphoma who presented with pleural effusions were reviewed. Thoracentesis was performed using the Seldinger technique.
Results:
Four of the children presented with symptoms and chest radiograph findings similar to pneumonia. A large mediastinal mass was present in two children. Pleural fluid analysis resulted in a definitive diagnosis of lymphoma in five of the six children. Two of the children had symptoms of reexpansion pulmonary edema after removal of pleural fluid. An empyema developed in one child after thoracotomy and chest tube placement. Reaccumulation of pleural fluid was common before initiating chemotherapy.
Conclusions:
Malignant pleural effusions frequently are present in children with non-Hodgkin's lymphoma. They may present with respiratory distress because of the size of the effusion, the mediastinal mass, or both. Management of these pleural effusions is associated with potential complications, some of which are life threatening. Thoracentesis is the initial diagnostic and therapeutic procedure of choice. The use of a Seldinger technique for thoracentesis has proved useful and safe. In patients with large effusions, aggressive removal of the pleural fluid may be followed by reexpansion pulmonary edema.