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First page of Clinical significance and prognosis of non-expandable lungs in patients with unilateral pleural effusion.

Introduction: Non-expandable lung (NEL) is a clinical condition where the lung fails to fully expand after pleural effusion drainage, due to pleural disease or bronchial obstruction. Despite its relevant clinical implications, NEL remains under-researched. This study aimed to evaluate the prevalence and clinical significance of NEL in patients with unilateral exudative pleural effusion and to assess its impact on prognosis, complications, and treatment options. Methods: A retrospective analysis of 518 medical thoracoscopy (MT) procedures performed in a University pulmonology center, from 2010 to 2020 was conducted. Results: NEL was identified in 24.9% of benign pleural effusions (BPE) and 19.0% of malignant pleural effusions (MPE). In BPE, NEL was more common in older males and associated with mediastinal shift post-drainage. In MPE, NEL significantly increased diagnostic complications (19.2% vs. 3.2%, p = 0.0002) and reduced the likelihood of receiving specific oncological treatments (50.0% vs. 71.6%, p = 0.005). Survival analysis revealed poorer outcomes for NEL patients. In BPE, NEL was associated with a threefold higher mortality risk over three years (HR = 3.142, p = 0.0005). Similarly, MPE patients with NEL had a median survival of 8.5 months compared to 16 months for those with re-expandable lungs (HR = 1.695, p = 0.0008). Conclusion: These findings highlight NEL as a critical prognostic factor in exudative pleural effusions, warranting further research to improve diagnostic and therapeutic strategies tailored to this condition.

Journal Section:
Interventional Pulmonology
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S. Karger AG, Basel
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2025
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