Assessment of Diaphragmatic Mobility by chest Ultrasound and Basic Echocardiography in Patients with Malignant Pleural Effusion Undergoing Pleurodesis

Abstract

Malignant pleural effusion (MPE) is a term that refers to the presence of malignant cells in pleural fluid or pleural tissue. MPE is a common complication of advanced-stages of malignancies (Tsai et al., 2012). Pleurodesis done to achieve a symphysis between visceral and parietal pleural layers, in order to prevent accumulation of either air or fluid in the pleural space. Its main indications are malignant pleural effusions and pneumothorax (Chen et al., 2013). Pleurodesis can be done chemically or surgically chemicals such as Bleomycin, Tetracycline, Povidone iodine and talc. Surgical pleurodesis may be performed via thoracotomy or thoracoscopy. This involves mechanically irritating the parietal pleura (Saka et al., 2016). The chest ultrasound can easily visualize pleural effusions, they are characterized by the echo-free space between the visceral and parietal pleura whose shape can change with respiration (Yang et al., 1992). Diaphragm is the principal generator of tidal volume in normal subjects at rest. Studies have shown that the impairment of diaphragm mobility might be associated with alterations in the principal pulmonary function parameters (Ricoy et al., 2019). Transthoracic echocardiography (TTE) is one such tool and is widely available and safe. In addition to its role in diagnosis, it can be used to screen for high-risk patient populations, to assess prognosis and to monitor disease stability and response to treatment (Zangiabadi et al., 2014). In most patients with malignant pleural effusion, palliative treatment requires pleurodesis with sclerosing agents. The most cost-effective method for controlling of malignant pleural effusion is drainage through thoracostomy tube and intrapleural instillation of a chemical agent "pleurodesis". The aim of this work is to assess both the diaphragmatic mobility using chest ultrasound and basic echocardiography before and after pleurodesis in patients with malignant pleural effusion undergoing pleurodesis. The present study was conducted at Abbassia Chest Hospital during the period between August 2018 and January 2020 and included thirty-five Patients who were proved to have malignant pleural effusion, diagnosis is based on positive pleural fluid cytology and/ or thoracoscopic biopsy. All the patients subjected to full history taking, clinical examination, routine radiographic (CXR and/or chest CT) and laboratory assessment. All the patients were fitted for chemical pleurodesis by bleomycin via Chest tube or pigtail insertion then fluid drainage was done. Pleural fluid cytology and/or