AM Report Pearls: Nephrostomy Tube Complications, Cystic Lung Dz

AM Report Pearls: Nephrostomy Tube Complications

  • How to place nephrostomy tube? Fluoroscopy-guided Seldinger technique – usually subcostal approach (below 12th rib) but rarely use intercostal approach (at 10th or 11th intercostal place) b/c of anatomy
    • Intercostal approach has higher rates of complications given diaphragmatic puncture
  • Most common complication is bleeding – usually manifests as hematuria for 1-3 days post-nephrostomy tube placement
    • Serious bleeding requiring transfusion is rare (1-3%)
  • Other complications are sepsis (1-2.5%), injury to nearby organs (0.1 – 0.3%)
  • Rarer complications: abscess formation, urinoma (pleural effusion with urine because of diaphragmatic puncture during placement), pneumothorax, air embolism, tube dislodgement.
  • Nice case report highlighting complications here: http://www.turner-white.com/pdf/hp_jun02_treat.pdf

AM Report Pearls: Ddx Cystic Lung Lesions

  • You can have primary cystic lung disease or acquired cystic lung disease
  • Primary cystic lung diseases:
    • Lymphangiomyomatosis  (LAM) – a disease of young women which can occur by itself or in association with tuberous sclerosis­- diffuse cysts seen throughout the lung
    • Langerhan’s cell histiocytosis – can be seen in young adult smokers
    • Some cases of LIP (lymphocytic interstitial pneumonia)
  • Acquired cystic lung disease:
    • Cystic fibrosis – more bronchiectasis seen over time
    • Sarcoidosis
    • End-stage IPF (usually subpleural location of cysts)
    • End-stage collagen vascular disease-related lung disease
    • Pneumocystis jirovecii pneumonia (formerly PCP) can be associated w/ upper-lobe predominant cysts
    • Pneumatoceles from trauma
  • I’m always a fan of Radiopaedia.org when I need to refresh myself on a Radiology ddx and look at some example CTs or CXRs – check out http://radiopaedia.org/articles/cystic-lung-disease-1
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