Diagnostic and treatment of fibrinothorax

Abstract

The OBJECTIVE was to promote the official introduction into clinical practice of the term «fibrinothorax» as a separate nosological unit and a special form of exudative pleurisy. This term reflects the essence and timing of the pathological process in the pleural cavity and defines a specific set of necessary therapeutic and diagnostic measures.METHODS AND MATHERIALS. 67 patients with fibrinothorax of different volumes were examined and treated. Two methods of pleural cavity sanitation were used: operative (thoracoscopic) and «closed» with the use of proteolytic enzymes.RESULTS. Among 67 patients, the leading cause of fibrinothorax was nonspecific (para- and metapneumonic) pleurisy – 48 (72 %) patients. In 7 (10 %) cases, fibrinothorax was established, which complicated the course of pleurisy of tuberculous etiology. In 6 (9 %) cases, pleural effusion was a transudate, in which, against the background of repeated punctures and long periods of fluid accumulation in the pleural cavity, partial delineations in the form of fibrinothorax formed. Carcinomatous pleurisy was diagnosed in 6 (9 %) patients of the study group. Pleural cavity sanitation through the use of proteolytic enzymes was performed in 49 (73 %) of 67 patients. Thoracoscopic sanitation with biopsy for fibrinothorax was performed in 18 (27 %) patients. This material formed the basis of the concept of diagnosis of fibrinothorax and optimization of treatment.CONCLUSION. The introduction of the term «fibrinothorax» into clinical practice, reflecting the essence of this pathological condition, contributes to the formation of a treatment and diagnostic algorithm aimed at the sanitation of the pleural cavity in optimal ways.

Keywords

• fibrinothorax
• sanitation of pleural cavity
• pleurography
• proteolytic enzymes
• thoracoscopy