Assessment of diaphragmatic mobility by chest ultrasound and basic echocardiography in patients with malignant pleural effusion undergoing pleurodesis

Background
Malignant pleural effusion (MPE) is prevalent, and in cases such as aging patients as well as increased long-term survival for metastatic cancers, the number of patients will continue to elevate in the near future.


Aim
To assess both the diaphragmatic mobility using chest ultrasound and basic echocardiography before and after pleurodesis in patients with MPE.


Patients and methods
This study included 35 patients with MPE; the diagnosis is based on positive pleural fluid cytology, thoracoscopic biopsy, and fitted for chemical pleurodesis by bleomycin. Baseline chest ultrasound was done to for assess the diaphragmatic mobility and basic echocardiography. Chemical pleurodesis was done through intrapleural injection of 1 IU/kg bleomycin as a sclerosing agent in 100 ml of normal saline.


Results
Regarding outcome, 17 (48.6%) patients succeeded (defined as absent lung sliding and no reaccumulation of pleural fluid in the lines examined) and 7 (20%) patients failed (known as reaccumulation of pleural fluid and (even with) no presence of lung sliding). There was a statistically substantial decrease in the diaphragmatic excursion (mobility) at 2 weeks and at 2 months after pleurodesis than before. A significant relation was detected between outcome of the studied patients with lung sliding before pleurodesis, whereas there was a substantial increase in pleurodesis success with no presence of lung sliding at 2 weeks and at 2 months after pleurodesis.


Conclusion
Ultrasound of the diaphragm is an uncomplicated, noninvasive method for estimating the contractile activity of diaphragm. The decrease in the diaphragmatic excursion at 2 weeks and at 2 months after pleurodesis compared with that before pleurodesis can be used as sign to predict pleurodesis success. There is no significant relation between echocardiography measurements and outcome except that normal left ventricle ejection fraction % has a significant relation with increased success outcome.