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Updated: May 7, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
[Could pleural aspergillosis happen to be a complication of pleural drainage?]
J Bellamy1, F Onea1, P N'Guyen Huu2
1Clinique du Val d'Or, 16, rue Pasteur, 92210 Saint-Cloud, France; Hôpital privé Claude-Galien, 91480 Quincy-Sous-Sénart, France.
Abstract:
Four cases of nosocomial aspergillosis are described where the responsibility of pleural drainage is advocated. Infection was pulmonary once, pleural three times. Pleural suction had been long lasting with incomplete re-expansion of the lung and major air leaks. The hypothesis of the responsibility of pleural drainage in the advent of aspergillosis is reinforced by the revision of medical papers, which leads to the conviction that similar cases have been described yet, even though the mechanism of the contamination had not been understood. Prevention needs to limitate the lasting of the suction, especially if there are major air leaks. Cure needs total re-expansion of the lung and suppression of any pleural cavity, even if a thoracoplasty is needed. An anti-fungal therapy is not always needed.
Insights
Nosocomial aspergillosis can arise from prolonged pleural drainage, especially with air leaks. Limiting suction duration and ensuring lung re-expansion are key preventive and treatment strategies.
Area of Science:
- Medical Mycology
- Thoracic Surgery
- Infectious Diseases
Background:
- Nosocomial aspergillosis is a serious fungal infection acquired in healthcare settings.
- Pleural drainage is a common procedure for managing thoracic conditions.
- The link between pleural drainage and aspergillosis has been an area of investigation.
Observation:
- Four cases of nosocomial aspergillosis were identified.
- Three of the four infections involved the pleura.
- Patients experienced prolonged pleural suction with incomplete lung re-expansion and significant air leaks.
Findings:
- The study advocates for the responsibility of pleural drainage in the development of aspergillosis.
- A review of medical literature supports this hypothesis, noting similar undiagnosed cases.
- Contamination likely occurs through the pleural drainage system.
Implications:
- Preventive measures should focus on minimizing the duration of pleural suction, particularly when major air leaks are present.
- Treatment requires complete lung re-expansion and obliteration of the pleural space, potentially necessitating a thoracoplasty.
- Antifungal therapy may not always be required for cure.
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