Categories
Diagnonistic Test

Transrectal Ultrasound and Biopsy of the Prostate

[amazon_link asins=’1841841927,B00FC5M71S,3540672524,1844630412′ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’0fe64772-dcf4-11e7-9ba1-d53fbd28ba3b’]

What is the test?
Your doctor is likely to recommend this test if you’ve had a rectal exam or blood tests that suggest that you might have prostate cancer. For this test, a urologist takes tissue samples from several places in your prostate, to be examined for cancer. A transrectal ultrasound helps the urologist see the prostate during the procedure.

………..CLICK & SEE THE PICTURES
How do you prepare for the test?
Some doctors recommend that you have an enema before the test. Tell your doctor if you have any allergies, especially to antibiotics.

What happens when the test is performed?
In most cases, you lie on your side with your knees bent up to your chest. An ultrasound machine’s sensor-a short rod about the width around of two fingers-is covered with a condom and clear jelly and gently inserted into your rectum. You may feel some pressure similar to the sensation before a bowel movement. Once the sensor is in place, an image of your prostate appears on a video screen.

The ultrasound sensor surveys the whole prostate gland and pinpoints specific areas for biopsy. Then the doctor removes this ultrasound sensor and replaces it with a slightly smaller one. In addition to generating an ultrasound image, the smaller sensor has a small tube on its side called a needle guide. Your doctor points the needle guide at specific parts of your prostate. The guide releases a spring-loaded needle to take biopsies from different parts of the prostate. The spring-loading allows this needle to move into and out of the prostate very quickly. You are likely to feel some discomfort from each biopsy, but because the needle moves so quickly, any pain lasts only for a second at a time. Doctors usually collect multiple samples.Your doctor will probably give you antibiotics at the end of this procedure to prevent infection.

What risks are there from the test?
Many people have some blood in their urine or stool for a day or two after the biopsy. The only significant risk is the possibility of an infection in the prostate, but antibiotics can help prevent this.

Must you do anything special after the test is over?
Call your doctor if you develop a fever.

How long is it before the result of the test is known?
A pathologist will examine the biopsies under a microscope for cancer. This process usually requires several days.

For more knowledge & information you may click :-http://emedicine.medscape.com/article/457757-overview

Source:https://www.health.harvard.edu/fhg/diagnostics/transrectal-ultrasound-and-biopsy-of-the-prostate.shtml

Reblog this post [with Zemanta]
Categories
Diagnonistic Test

Bone Marrow Biopsy

[amazon_link asins=’0443081107,B006NO3EZK,0340740892,B017MDO9MC,B004GXATC6,3805538634,3642622968,0497001667,B00ET6DRV0′ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’b7bb6803-454d-11e7-b04d-afa9c178e4cb’]

Introduction: Bone marrow is the spongy material found in the center of most large bones in the body. The different cells that make up blood are made in the bone marrow. Bone marrow produces red blood cells, white blood cells, and platelets. Along with a biopsy (the sampling of mostly solid tissue or bone), an aspiration (the sampling of mostly liquid) is often done at the same time.

…………….....CLICK & SEE

Doctors can diagnose many problems that cause anemia, some infections, and some kinds of leukemia or lymphoma cancers by examining a sample of your bone marrow (the tissue where blood cells are made). A bone marrow biopsy is the procedure to collect such a sample. It is done using a large needle inserted through the outside surface of a bone and into the middle of the bone, where the marrow is.

Why the procedure is performed: A bone marrow aspiration and biopsy procedure is done for many reasons.

*The test allows the doctor to evaluate your bone marrow function. It may aid in the diagnosis of low numbers of red blood cells (anemia), low numbers of white blood cells (leukopenia), or low numbers of platelets (thrombocytopenia), or a high number of these types of blood cells.

*The doctor can also determine the cause of some infections, diagnose tumors, determine how far a disease, such as lymphoma, has progressed, and evaluate the effectiveness of chemotherapy or other bone marrow active drugs.

*Where the procedure is performed: Bone marrow aspirations and biopsies can be performed in doctor’s offices, outpatient clinics, and hospitals. The procedure itself takes 10-20 minutes.

Preperation for the test:
You will need to sign a consent form giving your doctor permission to perform this test. Because you will probably receive some pain medicines or anti-anxiety medications that can make you drowsy, you will need to arrange a ride home.

Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Also talk with your doctor before the test if you are taking insulin, or if you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting. It may be necessary to stop or adjust the dose of these medicines before your test. Most people need to have a blood test done some time before the procedure to make sure they are not at high risk for bleeding complications.

*You may receive instructions about not eating food or drinking liquids before the procedure.

*Be sure to tell your doctor about any prescription medications, over-the-counter medications, as well as herbal supplements you are taking.

*Notify your doctor about all allergies, previous reactions to medications, if you have had any bleeding problems in the past, or if you are pregnant.

*Before the procedure, you will be asked to change into a patient gown.

*Your vital signs-blood pressure, heart rate, respiratory rate, and temperature-will be measured.

*Depending on your doctor, you may have an IV placed or your blood drawn.

*You may be given some medicine to help you relax.

*You may be asked to position yourself on your stomach or your side depending on the site the doctor chooses to use.

Risk Factors:
You will be asked to sign a consent form before the procedure. You will be notified of the alternatives as well as the potential risks and complications of this procedure.

Risks are minimal.

Possible risks include these:

*Persistent bleeding and infection

*Pain after the procedure

*A reaction to the local anesthetic or sedative

Having a sample taken is not harmful for your bone or bone marrow. Injury of nearby tissue from the biopsy is very uncommon. You might have some buttock soreness for a few days, and you may have some bruising at the biopsy site. A few individuals have an allergy or a side effect from the pain medicine or anti-anxiety medicine.

What happens when the test is performed?
Most patients have this test done by a hematologist in a clinic procedure area. You wear a hospital gown during the procedure. A sedative may be injected at this time. (If you are prescribed a sedative in pill form, you will be instructed to take it ahead of time.)

*Most patients have bone marrow sampled from the pelvis. You lie on your stomach and the doctor feels the bones at the top of your buttock. An area on your buttock is cleaned with soap. A local anesthetic is injected to numb the skin and the tissue underneath the skin in the sampling area. This causes some very brief stinging.

*The doctor will choose a place to withdraw bone marrow. Often this is the hip (pelvic bone), but it also can be done from the breastbone (sternum), lower leg bone (tibia), or backbone (vertebra).

*The chosen site will be cleaned with a special soap (iodine solution) or alcohol. After the skin is clean, sterile towels will be placed around the area. It is important that you do not touch this area once it has become sterile.

*Local anesthetic, usually lidocaine, will be injected with a tiny needle at the site. Initially, there may be a little sting followed by a burning sensation. After a few minutes, the site will become numb. A needle is then placed through the skin and into the bone. You may feel a pressure sensation.

*For the bone marrow aspiration, a small amount of bone marrow is then pulled into a syringe.

*A bone marrow biopsy is then usually performed. A somewhat larger needle is then put in the same place and a small sample of bone and marrow is taken up into the needle.

*After taking the liquid sample, the doctor carefully moves the needle a little bit further into the bone marrow to collect a second sample of marrow called a core biopsy. This core biopsy is a small solid piece of bone marrow, with not just the liquid and cells but also the fat and bone fibers that hold them together. After the needle is pulled out, this solid sample can be pushed out of the needle with a wire so that it can be examined under a microscope. Pressure is applied to your buttock at the biopsy location for a few minutes, until you are not at risk of bleeding. A bandage is placed on your buttock.
Must you do anything special after the test is over?
You will feel sleepy from the medicines used to reduce pain and anxiety.
After the local anesthetic wears off over the next few hours, you may have some discomfort at the biopsy site. Your doctor will advise you about pain medication.Once these medicines have worn off (a few hours after the test), you can return to normal activities, but you should not drive or drink alcohol for the rest of the day.

You should keep the bandage on for 48 hours, and then it should be removed.

After the test:
The samples taken from your bone marrow will be sent to a laboratory and the pathologist for analysis. Several tests are done including looking at the bone marrow under a microscope. The results of these tests will usually be available in a few days. Your doctor will give you instructions for follow-up.

When to Seek Medical Care:
Call your doctor if you notice signs of spreading redness, continued bleeding, fever, worsening pain, or if you have other concerns after this procedure.

Go to a hospital’s emergency department if these conditions develop:

*If your bleeding will not stop with direct pressure
*If you see thick discharge from the wound
*If you have a persistent fever
*If you feel lightheaded

How long is it before the result of the test is known?
Some parts of your bone marrow biopsy report may be available within a day, but some tests require special stains or tests that can take longer, in some cases up to one week.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/bone-marrow-biopsy.shtml
http://www.emedicinehealth.com/bone_marrow_biopsy/article_em.htm

Categories
Diagnonistic Test

Electrophysiological Testing of the Heart

[amazon_link asins=’B01MSDU0SN’ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’b500f3b2-04ff-11e8-b61b-f1b8df262b6d’]

Definition:
An electrophysiology (EP) study is a test that records the electrical activity and the electrical pathways of your heart. This test is used to help determine the cause of your heart rhythm disturbance and the best treatment for you. During the EP study, your doctor will safely reproduce your abnormal heart rhythm and then may give you different medications to see which one controls it best or to determine the best procedure or device to treat your heart rhythm.
CLICK & SEE.
Sometimes doctors will recommend a treatment called ablation that can be done during EPS testing. Ablation uses electricity to kill the cells in the heart muscle that seem to cause the abnormal rhythm.

You may click to see:->Electrophysiology Study

 

Why Do you Need an Electrophysiology Study?
*To determine the cause of an abnormal heart rhythm.

*To locate the site of origin of an abnormal heart rhythm.

*To decide the best treatment for an abnormal heart rhythm.

Sometimes an EP study is conducted before implantable cardioverter/defibrillator (ICD) placement to determine which device is best and afterwards to monitor treatment success.

How do you prepare for the test?
*You will need to sign a consent form giving your doctor permission to perform this test. Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Also tell your doctor if you have ever had an allergic reaction to any heart medicines.

*Talk with your doctor ahead of time if you are taking insulin, or if you take aspirin, nonsteroidal antiinflammatory drugs, or other medicines that affect blood clotting. It may be necessary to stop or adjust the dose of these medicines before your test. Most people need to have a blood test done some time before the procedure to make sure they are not at high risk for bleeding complications.

*Your doctor may tell you not to eat anything for 12 or more hours before the test. A few people require an anti-anxiety medicine which occasionally causes nausea, and therefore some doctors prefer to have you come with an empty stomach. You might need to plan to spend the night in the hospital afterwards for recovery.

*Ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications one to five days before your EP study. If you have diabetes, ask your doctor how you should adjust your diabetes medications.

*Do not eat or drink anything after midnight the evening before the EP study. If you must take medications, take them only with a small sip of water.

*When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry or valuables at home.

*Your doctor will tell you if you can go home or must stay in the hospital after the procedure. If you are able to go home, bring a companion to drive you home.

What happens when the test is performed?
The test is done by a specialist using equipment and cameras in the cardiology department. You wear a hospital gown and lie on your back during the procedure. You have an IV (intravenous) line placed in a vein in case you need medicines or fluid during the procedure. Your heart is monitored during the test.

A catheter (a hollow, sterile tube that resembles spaghetti) is inserted through the skin into a blood vessel-typically in your groin, but possibly in the neck or arm. Before the catheter is placed, medicine through a small needle is used to numb the skin and the tissue underneath the skin in that area. The numbing medicine usually stings for a second. A needle on a syringe is then inserted, and some blood is drawn into the syringe, so that the doctor knows exactly where the blood vessel is located. One end of a wire is threaded into the blood vessel through the needle and the needle is pulled out, leaving the wire temporarily in place. This wire is several feet long, but only a small part of it is inside your blood vessel. The catheter can then be slipped over the outside end of the wire and moved forward along it like a long bead on a string, until it is in place with one end inside the blood vessel. The wire is pulled out of the catheter, leaving the catheter in place. Now the catheter can be moved easily forwards and backwards inside your blood vessel by the doctor, who holds the outside end of the catheter while using special controls to point the tip of the catheter in different directions. The doctor carefully moves the catheter to the large blood vessels in your chest and into the chambers of your heart.

As your physician maneuvers the catheter, he or she watches a live video x-ray to know exactly where the catheter is. Instruments on the tip of the catheter allow it to sense electrical patterns from your heart and also to deliver small electrical shocks to the heart muscle (or a stronger electrical burn if you are having ablation). The electrical shocks, too small for you to feel, are used to “tickle” the heart muscle in different places to see if your abnormal rhythm is triggered by one sensitive area of your heart. If the rhythm changes, your doctor gives you small doses of different medicines through this catheter to see which ones work best to change the rhythm back to normal. In some cases the doctor may need to give your heart some additional mild shocks to get it back into a normal rhythm. Because this catheter is in place inside your heart and can give the shocks directly to the heart muscle, very small amounts of electricity are used.

After the catheter has been pulled out, a pressure bandage (basically a thick lump of gauze) is taped tightly to your groin to reduce bleeding. The test usually requires one to two hours to perform.

Many patients are able to feel palpitations (an irregular or fast heartbeat) from the rhythm changes. A few patients also experience shortness of breath or dizziness when they are not in a normal heart rhythm. Other than the brief sting of the numbing medicine and some soreness in your groin area afterward, you are not likely to feel any pain. For some people, the procedure provokes anxiety. Some patients also have a difficult time lying still for the time it takes to perform this test.
What Can you Expect During the Electrophysiology Study?
*You will lie on a bed and the nurse will start an intravenous (IV) line into your arm or hand. This is so you can receive medications and fluids during the electrophysiology study. You will be given a medication through your IV to relax you and make you drowsy, but it will not put you to sleep.

*The nurse will connect you to several monitors.
Your groin will be shaved and cleansed with an antiseptic solution. Sterile drapes are used to cover you, from your neck to your feet. A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

An electrophysiologist (a doctor who specializes in the diagnosis and treatment of abnormal heart rhythms) will numb your groin with medication and then insert several catheters into the vein in your groin. Guided by the fluoroscopy machine, the catheters are threaded to your heart. The catheters sense the electrical activity in your heart and are used to evaluate your heart’s conduction system. The doctor will use a pacemaker to deliver the electrical impulses through one of the catheters to increase your heart rate.

You may feel your heart beating faster or stronger. Your nurses and doctor will want to know about any symptoms you are feeling. If your arrhythmia occurs, your doctor may give you medications through your IV to test their effectiveness in controlling it. If necessary, a small amount of energy may be delivered by the patches on your chest to bring back a normal heart rhythm. Based on the information collected during the study, the doctor may continue with an ablation procedure or device implant (pacemaker or ICD).

The EP study takes about two to four hours to perform. However, it can take longer if additional treatments such as catheter ablation are performed at the same time.

Risk Factors:
There are significant risks from this procedure. Most important, some abnormal heart rhythms (arrhythmia) can be life-threatening, and your doctors will purposefully cause you to go through a few extra episodes of arrhythmia during the testing. If your doctors recommend electrophysiologic testing, they feel that this is a risk worth taking because it will allow them to take better care of you in the future. Because you are right in the lab and attached to a monitor while you undergo the rhythm changes, it is easy for them to treat you should your arrhythmia occur and cause you symptoms.

Ablation has some additional risks, because it intentionally causes some scarring of a small part of the heart muscle. Complications are rare, but new rhythm changes can occur. A very rare complication occurs if the ablation instrument burns a hole through the heart muscle. This causes bleeding and may require immediate surgery.

There are some more minor risks from the test. Among them is bleeding from the place where the catheter was inserted. If bleeding occurs but the blood collects under the skin, it can form a large painful bruise called a hematoma. A few people are allergic to the medicines used in the procedure, and this can cause a rash or other symptoms.

Must you do anything special after the test is over?
You will need to lie flat for around six hours after this procedure. If you received anti-anxiety medicine through your IV during the procedure, you might feel sleepy at the end of the procedure and you might not remember much of the test. You should not drive or drink alcohol for the rest of the day.

Depending on what happened during your test, you might need to wear a heart monitor in the hospital for a few hours or overnight.

What Happens After the EP Study?
The doctor will remove the catheters from your groin and apply pressure to the site, to prevent bleeding. You will be on bed rest for about one to two hours.

An EP study can be frightening, but this test allows the doctor to decide the best treatment for you. In many cases, EP testing and the therapy following can greatly reduce the likelihood of spontaneous arrhythmia. If you have any questions, do not hesitate to ask your doctor or nurse.

How long is it before the result of the test is known?
Your doctors can tell you how the testing went as soon as it is over. If you had ablation done, the results will not be certain until you have had some time to see if your arrhythmia seems to be under control after the treatment.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/electrophysiological-testing-of-the-heart.shtml
http://www.webmd.com/heart-disease/guide/diagnosing-electrophysiology

http://www.londoncardiac.ca/pages/bfs.html

Reblog this post [with Zemanta]
Categories
Diagnonistic Test

Pulmonary Function Tests

[amazon_link asins=’145114380X,0323085059,0198702469,0702035203,1451107137,159103440X,1848822308,1609714865,0323020062′ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’04ef9c5a-5f9f-11e7-9bf8-773863ad328b’]

Alternative Names: PFTs; Spirometry; Spirogram; Lung function tests
Definition:Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move oxygen into the blood. These tests can tell your doctor what quantity of air you breathe with each breath, how efficiently you move air in and out of your lungs.
.CLICK & SEE
Pulmonary Function Testing has been a major step forward in assessing the functional status of the lungs as it relates to :

1.How much air volume can be moved in and out of the lungs
2.How fast the air in the lungs can be moved in and out
3.How stiff are the lungs and chest wall – a question about compliance
4.The diffusion characteristics of the membrane through which the gas moves (determined by special tests)
5.How the lungs respond to chest physical therapy procedures

Pulmonary Function Tests are used for the following reasons :

1.Screening for the presence of obstructive and restrictive diseases

2.Evaluating the patient prior to surgery – this is especially true of patients who :
a. are older than 60-65 years of age
b. are known to have pulmonary disease
c. are obese (as in pathologically obese)
d. have a history of smoking, cough or wheezing
e. will be under anesthesia for a lengthy period of time
f. are undergoing an abdominal or a thoracic operation

Note
: A vital capacity is an important preoperative assessment tool. Significant reductions in vital capacity (less than 20 cc/Kg of ideal body weight) indicates that the patient is at a higher risk for postoperative respiratory complications. This is because vital capacity reflects the patient’s ability to take a deep breath, to cough, and to clear the airways of excess secretions.

3.Evaluating the patient’s condition for weaning from a ventilator. If the patient on a ventilator can demonstrate a vital capacity (VC) of 10 – 15 ml/Kg of body weight, it is generally thought that there is enough ventilatory reserve to permit (try) weaning and extubation.

4.Documenting the progression of pulmonary disease – restrictive or obstructive

5.Documenting the effectiveness of therapeutic intervention

How do you prepare for the test?
Do not eat a heavy meal before the test. Do not smoke for 4 – 6 hours before the test. You’ll get specific instructions if you need to stop using bronchodilators or inhaler medications. You may have to breathe in medication before the test.

No other preparation is necessary.

How the Test Will Feel ?
Since the test involves some forced breathing and rapid breathing, you may have some temporary shortness of breath or light-headedness. You breathe through a tight-fitting mouthpiece, and you’ll have nose clips.

What happens when the test is performed?
This testing is done in a special laboratory. During the test, you are instructed to breathe in and out through a tube that is connected to various machines.

A test called spirometry measures how forcefully you are able to inhale and exhale when you are trying to take as large a breath as possible. The lab technicians encourage you to give this test your best effort, because you can make the test result abnormal just by not trying hard.

A separate test to measure your lung volume (size) is done in one of two ways. One way is to have you inhale a small carefully measured amount of a specific gas (such as helium) that is not absorbed into your bloodstream. This gas mixes with the air in your lungs before you breathe it out again. The air and helium that you breathe out is tested to see how much the helium was diluted by the air in your lungs, and a calculation can reveal how much air your lungs were holding in the first place.

The other way to measure lung volume is with a test called plethysmography. In this test, you sit inside an airtight cubicle that looks like a phone booth, and you breathe in and out through a pipe in the wall. The air pressure inside the box changes with your breathing because your chest expands and contracts while you breathe. This pressure change can be measured and used to calculate the amount of air you are breathing.

Your lungs’ efficiency at delivering oxygen and other gases to your bloodstream is known as your diffusion capacity. To measure this, you breathe in a small quantity of carbon monoxide (too small a quantity to do you any harm), and the amount you breathe out is measured. Your ability to absorb carbon monoxide into the blood is representative of your ability to absorb other gases, such as oxygen.

Some patients have variations of these tests-for example, with inhaler medicines given partway through a test to see if the results improve, or with a test being done during exercise. Some patients also have their oxygen level measured in the pulmonary function lab (see “Oxygen saturation test,” page 29).

Why the Test is Performed  ?

Pulmonary function tests are done to:
*Diagnose certain types of lung disease (especially asthma, bronchitis, and emphysema)
*Find the cause of shortness of breath
*Measure whether exposure to contaminants at work affects lung function
It also can be done to:

*Assess the effect of medication
*Measure progress in disease treatment
*Spirometry measures airflow. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases.

Lung volume measures the amount of air in the lungs without forcibly blowing out. Some lung diseases (such as emphysema and chronic bronchitis) can make the lungs contain too much air. Other lung diseases (such as fibrosis of the lungs and asbestosis) make the lungs scarred and smaller so that they contain too little air.

Testing the diffusion capacity (also called the DLCO) allows the doctor to estimate how well the lungs move oxygen from the air into the bloodstream.

Risk Factors:
The risk is minimal for most people. There is a small risk of collapsed lung in people with a certain type of lung disease. The test should not be given to a person who has experienced a recent heart attack, or who has certain other types of heart disease.

Must you do anything special after the test is over?
Nothing.

Normal Results:
Normal values are based upon your age, height, ethnicity, and sex. Normal results are expressed as a percentage. A value is usually considered abnormal if it is less than 80% of your predicted value.

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean:
Abnormal results usually mean that you may have some chest or lung disease.

Considerations:
Your cooperation while performing the test is crucial in order to get accurate results. A poor seal around the mouthpiece of the spirometer can give poor results that can’t be interpreted. Do not smoke before the test.

How long is it before the result of the test is known?
Your doctor will receive a copy of your test results within a few days and can review them with you then.

Resources:
https://www.health.harvard.edu/diagnostic-tests/pulmonary-function-testing.htm
http://www2.nau.edu/~daa/lecture/pft.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003853.htm

Reblog this post [with Zemanta]
Categories
Diagnonistic Test

Pleural Fluid Sampling (or Thoracentesis)

Pleural effusion Chest x-ray of a pleural effu...
Image via Wikipedia

[amazon_link asins=’B01J8WALE0,B00GNOPG8S,1331951720,1893441776,B01MXOPZIB,B01J2IC12U,B01J37411E,B009KT2GWM,B01J2GLUVU’ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’316e2df4-5fab-11e7-aab1-4db380a805de’]


Definition:
Thoracentesis is a procedure used to obtain a sample of fluid from the space around the lungs. Normally, only a thin layer of fluid is present in the area between the lungs and chest wall (show radiograph 1). However, some conditions can cause a large amount of fluid to accumulate. This collection of fluid is called a pleural effusion (show radiograph 2). Thoracentesis is done to collect a sample of the fluid, which can help determine why the pleural effusion developed.
CLICK & SEE
Some infections and diseases cause fluid to accumulate in the space between the lung and the rib cage or between the lung and the diaphragm. This collection of fluid is called a pleural effusion. A pleural effusion might be detected on a chest x-ray. Sampling this fluid is important because it enables doctors to understand what caused the fluid to collect and how to treat the problem. The fluid can be sampled with a needle.

Reasons for Thoracentesis: — A thoracentesis is performed to determine the cause of a pleural effusion. In some cases, a physician may perform thoracentesis to relieve symptoms caused by the pleural effusion, including shortness of breath and low blood oxygen levels. A pleural effusion may be detected during a physical examination or on a chest x-ray.

Pleural effusion can be caused by many different conditions, including infections, heart failure, cancer, or tuberculosis. In some cases, blood or other fluid may be leaking into the pleural space from another part of the body, causing the effusion. By examining the fluid and the types of cells it contains, the cause of the effusion can usually be determined.

In general, there is no reason a thoracentesis cannot be performed. The procedure is more easily performed and complications are fewer when the pleural effusion is large. Special consideration may be necessary in patients who are on respirators.

Patients who have a bleeding disorder or who are on medications that affect blood clotting may need extra care to minimize the risk of bleeding. Patients should tell their healthcare provider if they have a history of bleeding problem or if they are taking medicine that decreases blood clotting. In some cases, a blood test will be taken prior to the procedure to exclude any blood clotting abnormalities caused by disease or medications.

Procedure: A thoracentesis involves the following steps:

*The patient will be placed in a position that allows the doctor to easily access the effusion. Usually, the patient is asked to sit upright during the procedure. It is important to remain still during the procedure so that the fluid does not shift.

*The skin is cleaned with an antibacterial solution in the area where the needle will be inserted.

*A small amount of numbing medicine (a local anesthetic, similar to novocaine) is injected into the area. This medicine helps minimize discomfort during the procedure.

*A slightly larger needle is inserted in the same location. A syringe is attached to this needle and is used to withdraw fluid from around the lung. Patients who have symptoms from the effusion (eg, shortness of breath) may have a large amount of fluid removed, which allows the lung to re-expand.

*The needle is removed and pressure is briefly applied to the insertion site.

How do you prepare for the test?
You will need to sign a consent form giving your doctor permission to perform this test. Some patients have this test done in a doctor’s office, while others are admitted to the hospital for it. Generally your doctor will decide whether you need to be in the hospital based on your medical condition. A chest x-ray or an ultrasound is done before the procedure.

Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. If you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.

What happens when the test is performed?
You wear a hospital gown and sit on a bed or table leaning forward against some pillows. The doctor listens to your lungs with a stethoscope and may tap on your back to find out how much fluid has collected.

Soap is used to disinfect an area of skin on one side of your back. A small needle is used to numb a patch of skin between two of your lower ribs. The numbing medicine usually stings for a second. A needle on an empty syringe is then inserted into the fluid pocket. Usually this pocket is around one inch below the skin surface. You might feel some minor pressure as the needle is inserted. Depending on the quantity of fluid that the doctor plans to remove, either the syringe itself is filled or soft plastic tubing is used to remove fluid into a collection bag or jar. While the doctor is attaching the tubing, he or she might ask you to hum out loud. This humming is for your safety: It prevents you from taking a deep breath, which could expand your lung, causing it to touch the needle.

It sometimes takes 15 minutes or longer to remove the necessary amount of fluid. Most patients feel no discomfort during this time, although a few patients feel some chest pain at the end of the procedure as their lung expands and touches the chest wall. After the fluid is removed, a bandage is placed on your back.

Risk Factors:
This procedure carries a few serious risks, but most patients have no complications. If the needle touches the lung it may create an air leak, which is seen on the x-ray and might require you to stay in the hospital for a few days. Some patients with this complication need to have a plastic tube (called a chest tube) inserted between two ribs. The tube uses vacuum pressure to keep the lung expanded until it has healed.

In most cases, a thoracentesis is performed without complications. Most complications are minor and resolve on their own or are easily treated. Potential complications include the following:

*Pain — Some discomfort may occur when the needle is inserted. Using a local anesthetic helps to reduce the pain. Pain generally resolves once the needle is removed.

*Bleeding — A blood vessel may be nicked as the needle is inserted through the skin and chest wall, causing bleeding. The bleeding is usually minor and stops on its own, although it may cause bruising around the puncture site. In rare cases, bleeding into or around the lung may occur, requiring drainage or surgery.

*Infection
Infection can occur if bacteria are introduced by the needle puncture. Using disinfectant solution to clean the area and using sterile technique during the procedure minimizes this risk.

*Pneumothorax or collapsed lung Occasionally, the needle used to obtain a fluid sample can puncture the lung. The hole created by the puncture usually seals quickly on its own. If it does not, air can build up around the lung, causing the lung to collapse. This is called a pneumothorax. When a pneumothorax occurs, a chest tube may be used to drain the air and allow the lung to re-expand.

A pneumothorax may also occur if the lung fails to expand when fluid is withdrawn. This is considered to be a drainage-related pneumothorax, and is the most common type of pneumothorax to occur when ultrasound is used for needle placement. Drainage-related pneumothorax is most commonly caused by disorders of the surface lining of the lung and not by the puncture needle. Treatment is rarely needed.

Pneumothorax occurs in less than 12 percent of procedures. Those that do occur are usually small and resolve on their own. A chest tube to helps re-expand the lung is necessary only if the pneumothorax is large, continues to expand, or causes symptoms.

*Liver or spleen puncture — In very rare cases, the liver or spleen may be punctured during thoracentesis. Sitting upright and remaining still during the procedure helps to keep the liver and spleen away from the insertion area and minimizes the risk of this complication.

Must you do anything special after the test is over?
You will need to have an x-ray taken after the sampling is completed. Your breathing should feel the same (or better) after the procedure.

How long is it before the result of the test is known?
The fluid may be tested for a variety of things, including infection and cancer. Cells in the fluid will be examined. It may be several days before full results are available.

Where you may get more information:-Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:
Professional  Level Information:-
Diagnostic thoracentesis 
An overview of medical thoracoscopy
Diagnostic evaluation of a pleural effusion in adults
Imaging of pleural effusions in adults
Management of malignant pleural effusions

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

*American Thoracic Society
(www.thoracic.org)

*American Lung Association
(lungusa.org)

*National Heart Lung & Blood Institute
(www.nhlbi.nih.gov/index.htm)

*National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)

Resources:
https://www.health.harvard.edu/diagnostic-tests/pleural-fluid-sampling.htm
http://www.uptodate.com/patients/content/topic.do?topicKey=~0aPG4xpnulisDf

Reblog this post [with Zemanta]
css.php