Page 46 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED e-POSTER SESSION 02:
Diseases of the pleura
CARDIAC ANGIOSARCOMA WITH RECURRENT CARDIAC TAMPONADE TREATED WITH A PERICARDIAL WINDOW AND INDWELLING PLEURAL CATHETER
Syed Ajmal, Sarah Johnstone, Rakesh Panchal
Glenfield Hospital, University Hospitals of Leicester NHS Trust UK, Leicester, United Kingdom
PP09
Introduction: Primary cardiac neoplasms are extremely rare with majority of tumours being benign.The most common malignant histological subtype is angiosarcoma and is usually associated with a very poor prognosis. It can result in congestive cardiac failure, pericardial effusion and cardiac tamponade. In malignant pericardial effusions, surgical pericardial window (SPW) remains the most effective option for long term drainage to allow ongoing treatment. A percutaneous balloon pericardial window (PBPW) is another option, however most patients develop a left pleural effusion with large effusions potentially causing respiratory compromise. Here, we explore a case of a young gentleman with a primary cardiac angiosarcoma who was referred for a large left pleural effusion following PBPW that was successfully managed with an indwelling pleural catheter (IPC) and subsequent SPW.
Case study: A 45 year old gentleman with history of hypertension and supraventricular tachycardia presented 3 weeks earlier with worsening dyspnoea and syncopal episodes. He was found to have a large pericardial effusion and cardiac tamponade and was treated with a pericardiocentesis. A CT chest revealed a mass in the right atrium and multiple pulmonary metastasis. A CT guided lung biopsy of a pulmonary lesion demonstrated metastatic primary cardiac angiosarcoma. During the same admission, he had further cardiac tamponade and was treated with a PBPW. He was discharged well but presented 8 days later, again with cardiac tamponade but also a left tension hydrothorax. His cardiac tamponade was treated with a pericardial drain. He was then referred to the respiratory team for management of his left pleural effusion. A bedside thoracic ultrasound revealed a large left anechoic effusion with flattening of the hemidiaphragm and lung atelectasis. Following MDT discussion an IPC was inserted to allow ongoing drainage of the pleural cavity. He was subsequently referred to the surgeons for a SPW. This allowed drainage of pericardial fluid into the pleural cavity and subsequent drainage via the IPC. Patient was taught to manage and drain the IPC independently with minimal assistance on the ward and was subsequently discharged well. He was draining around 1000mls a day at home and was well on subsequent review.
Conclusion: This case demonstrates that IPCs have a role in managing pleural effusions that result from the creation of a pleuro-pericardial window in the management of malignant pericardial effusions.A SPW and IPC allow ongoing drainage and minimises the risk of recurrent cardiac tamponade and tension hydrothorax.
PP10
Introduction: Infectious pleural effusion (IPE) is a frequent diagnosis amidst pleural pathology that is frequently associated with high morbidity and mortality. Efforts in the prognostic stratification of IPE lead to the development of the RAPID (Renal function, Age, Purulence, Infection source and Dietary) score in 2014 that allowed to the identification of three risk categories (low, medium and high risk) independently associated with mortality at three months (3%, 9%, and 31% respectively). External validation of this score has seldom been performed and further studies in different cohorts may still prove valuable.
Methods: We conducted a cross sectional, monocentric, retrospective study based on the consultation of the clinical records of all patients who performed thoracocentesis from November 2016 to December 2018. Data regarding demographics, blood and pleural fluid analysis, mortality at 3 months, surgical intervention and hospital length stay were collected. A logistic regression model to assess mortality by RAPID risk category and survival analysis were performed using IBM SPSS v25®.
Results: We assessed a total of 200 patients of which 53 (26.5%) had a final diagnosis of IPE. Four patients were excluded from the study due to missing data. From the total of 49 patients included, 35 (71.4%) were male with a mean age of 69.9 (±17.31) years. According to the RAPID score, 12 (24.5%), 20 (40.8%) and 17 (34.7%) patients were stratified into low, medium and high risk, respectively, with a mortality at 3 months of 8.3%, 25.0% and 58.8%, accordingly.The hazard ratio for mortality at 3 months (with low risk as the comparator) for medium risk was 3.7 (95% CI 0.37-36.0, p=0.265) and for high risk 15.71 (95% CI, 1.63-151.13; p=0.017). Mean survival for low, medium and high risk was 7, 16 and 22 months, respectively (p=0.01,log rank test).The need for surgical intervention was 25.0%,5.0% and 0.0% and the mean length of hospital stay was 20.5, 18.6 and 25.4 days in low, medium and high risk, respectively.
Conclusion: In our 2-year retrospective cohort, the RAPID score was a useful tool to estimate survival at 3 months with results overlapping those of previous publications. In our sample, the probability of surgical referral addressed by this score was also in agreement with recent literature on this subject, but not length of hospital stay.
VALIDATION OF THE RAPID SCORE IN A 2-YEAR RETROSPECTIVE COHORT
Rebeca Martins Natal1, Gonçalo Samouco1, Luís Vaz Rodrigues1,2
1 Pulmonology Department, Sousa Martins Hospital, Local Health Unit of Guarda, Guarda, Portugal 2 Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
46 6th European Congress for Bronchology and Interventional Pulmonology