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