Post-Cardiac Surgery Pleural Effusion

Epidemiology

  • Incidence of Pleural Effusion Post-CABG: 42% of cases (as assessed by CXR)
    • Higher incidence, if assessed by thoracic U/S
  • Risk Factors: increased risk with LIMA graft (as compared to saphenous grafts)

Physiology

  • Trauma to Pleura During Procedure
    • No difference in LV-EF after procedure in cases with effusion: rules out CHF as the mechanism
  • Late Onset Post-CABG Pleural Effusion: large effusions may occur in some cases within 3 weeks-1 year after procedure
    • Due to peristent bleeding at LIMA harvest site, trapped lung, or unknown cause

Diagnosis

  • CXR/Chest CT Patterns
    • Usually small
    • Usually L>R sided
    • Pericardial effusion may also be present

Clinical

  • Pleural Effusion (see Pleural Effusion-Exudate, [[Pleural Effusion-Exudate]])
    • Thoracentesis in post-CABG setting is usually indicated only for late onset effusions (or early onset effusions that may be infected or increasing in size)

Treatment

  • Spontaneous Resolution: resolves within several weeks after surgery
  • Thoracoscopy: may be indicated for evaluation of late onset effusion
    • May allow release of trapped lung or may reveal pleural peel that requires decortication
    • Talc pleurodesis: indicated for recurrent effusion if no pleural peel is present

References

  • xx