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Introduction: Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate which combine trastuzumab (T), a monoclonal antibody targeting the human epidermal growth factor receptor-2 (HER2), and a cytotoxic molecule derived from maytansine (DM1). Case report: We report the first case of T-DM1-associated pleural and pericardial effusions three weeks after the second course of T-DM1 in a patient with breast cancer. Drug-induced pleural and pericardial effusions was implicated in the absence of other etiologies. The Naranjo Scale indicated a probable drug-induced adverse reaction. Management & outcome: The patient fully recovered after thoracentesis and discontinuation of T-DM1. The patient has reported no side effect after the sixth course of trastuzumab. Discussion: To our knowledge, this is the first case in the literature of bilateral pleural and pericardial effusions in a patient treated with T-DM1. The successful initiation of treatment with trastuzumab following withdrawal of T-DM1 suggests that emtansine played a role in the development of bilateral pleural and pericardial effusions. We hypothesize that the patient's condition was a result of a local inflammatory reaction to emtansine by direct toxicity. [ABSTRACT FROM AUTHOR]

Background: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). Methods: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. Results: Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P <.0001), 1-month (43.1% vs 36.1%, P <.0001), 6-month (63.6% vs 55.7%, P <.0001), and 1-year mortality (73.8% vs 66.1%, P <.0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P <.0001), ICU stay (7.3 vs 5.1 days, P <.0001), need for mechanical ventilation (63.1% vs 55.7%, P <.0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P <.0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P =.0002), 1-month (47.7% vs 39.7%, P =.0005), 6-month (67.1% vs 61.8%, P =.0161), and 1-year mortality (77.1% vs 72.1%, P =.0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P <.0001), ICU stay (9.2d vs 6.4 days, P <.0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P <.0001). Conclusions: The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients. [ABSTRACT FROM AUTHOR]

In this article, the author recommends use of several measures including treatment with broad-spectrum antibiotics, intrapleural administration of fibrinolytics and video-assisted thoracic surgery in case of parapneumonic effusion (PPE) in children. It mentions increased incidence of parapneumonic effusion (PPE) and empyema in younger children. It also mentions Streptococcus pneumoniae bacteria being common cause for the disease.

Prolonged chylothorax is a rare, life-threatening, pleural effusion that may be encountered in the setting of trauma. Conservative treatment may be successful and is the traditional approach in cases of limited chyle output. Early surgical intervention is required in cases with large refractory chyle output, but may be associated with substantial morbidity and mortality. Percutaneous thoracic duct embolization is an uncommon, minimally invasive, safe and effective treatment alternative. We report a case of successful thoracic duct embolization to treat large-volume chylothorax due to blunt trauma. [ABSTRACT FROM AUTHOR]

Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including reexpansion pulmonary edema. [ABSTRACT FROM AUTHOR]

This article describes a case study of pancreaticopleural fistula presenting as a recurrent pleural effusion that persisted requiring repeated thoracentesis despite endoscopic placement of pancreatic duct stents. The patient was a 48-year-old man who presented with acute pancreatitis that was presumed to be the result of gallstones and underwent laparoscopic cholecystectomy. His symptoms and fistula quickly resolved after an internal drainage through a Roux-en-Y pancreaticocyst-jejunostomy.