Thoracentesis
Alexandra J. Lopez, MD; Yu Maw Htwe, MD
Penn State Health Milton S. Hershey Medical Center
Pleural effusions are a frequent problem encountered in pulmonary medicine. Some common causes of pleural effusion include chest infection, heart failure, liver failure, malignancy, and autoimmune diseases such as rheumatoid arthritis, to name a few. Often drainage of this fluid is required for both diagnostic and therapeutic purposes, which is called thoracentesis. For this procedure, a Safe-T-Centesis kit is used to place a temporary catheter in the pleural space and manually drain the fluid, which can then be sent to the lab for further testing, including cell counts, glucose, pH, protein levels, cytology, and bacterial cultures. Based on these results, it can be determined if the effusion is exudative or transudative, which helps guide further management. In this case, the patient has a recurrent left-sided exudative effusion of unknown cause with underlying history of colon cancer, and malignant effusion is a concern, so it was decided to perform both diagnostic and therapeutic ultrasound-guided thoracentesis.
Diagnostic Hip Arthroscopy
Jason P. Den Haese Jr., DO1; Scott D. Martin, MD2
1Oklahoma State University Medical Center
2Brigham and Women’s/Mass General Health Care Center
Diagnostic hip arthroscopy is a minimally-invasive surgical technique used to accurately provide intraoperative information and potentially treat certain intra-articular (such as labral tears, chondral defects, and femoroacetabular impingement) and extra-articular (such as capsular tears, ischiofemoral impingement, and pediatric deformities) hip pathologies. The use of this procedure in the United States is becoming more common; annual rates are increasing by as much as 365% since 2004. Within this rapid increase of utilization, the three most common procedures being performed with diagnostic hip arthroscopy are labral repair, femoroplasty, and acetabuloplasty.
In this case, a young female athlete is being assessed for left anterior hip pain recalcitrant to nonoperative management. The patient was placed in a supine position with an anterolateral portal and modified anterior portal being placed into the left hip. A puncture capsulorrhaphy was performed to examine the labrum, femoral head, and transverse ligament. Then, the medial structures and peripheral compartment were visualized. Throughout the procedure, the only treatable hip pathology identified was labral fraying consistent with a minor labral tear. It was determined that the fraying was not significant enough to require surgical repair, so labral debridement was chosen. Other areas of labral fraying and fatty degeneration were identified, but they were not significant enough to be treated intraoperatively. The procedure was completed with no complications.
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