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Ultraschall in Der Medizin (Stuttgart,... Feb 2023Diseases of the respiratory system are among the main problems of premature patients in the neonatal intensive care unit. Radiography of the thorax is the gold standard...
Diseases of the respiratory system are among the main problems of premature patients in the neonatal intensive care unit. Radiography of the thorax is the gold standard of imaging. This results in high cumulative radiation exposure with potential negative long-term consequences. Ultrasound examination of thoracic structures represents a promising radiation-free and ubiquitously available alternative.A healthy, ventilated lung can only be imaged via artifacts, since total reflection of the sound waves occurs due to the high impedance difference between tissue and air-filled lung. Pathologies of pleura and subpleural lung tissue lead to changes in the acoustic properties of the tissue and thus to variations in the artifacts that can be imaged. The main sonographic characteristics of pulmonary pathology are: pleural line abnormalities, increased B-lines and comet-tail artifacts, lung consolidations, a visible pulmonary pulse, pleural sliding abnormalities, and visualization of effusions. Deviations from normal sonographic findings can be assigned to specific underlying pathophysiologies, so that conclusions about the disease can be drawn in conjunction with the clinical symptoms.
Topics: Infant, Newborn; Humans; Lung; Lung Diseases; Pleura; Ultrasonography; Diagnosis, Differential
PubMed: 36075237
DOI: 10.1055/a-1885-5664 -
Respiration; International Review of... 2022Thoracoscopy is the "gold standard" diagnostic modality for investigation of suspected pleural malignancy. It is postulated that meticulous assessment of the pleural...
BACKGROUND
Thoracoscopy is the "gold standard" diagnostic modality for investigation of suspected pleural malignancy. It is postulated that meticulous assessment of the pleural cavity may be adequate to indicate malignancy through the macroscopic findings of nodules, pleural thickening, and lymphangitis. We attempted to critically assess this practice, by precisely defining objective macroscopic criteria which might differentiate benign from malignant pleural diseases according to intrapleural pattern and anatomical location, and thereby to explore the predilection of abnormalities to specific sites on pleural surfaces.
METHODS
A structured review of recorded video footage from medical thoracoscopy procedures in 96 patients was conducted by 2 independent assessors. Abnormalities were scored on agreed, objective criteria for the presence of nodules, lymphangitis and inflammation on each of the costoparietal, visceral and diaphragmatic surfaces. The costoparietal pleura was divided into 6 levels (apical, middle, and inferior surfaces of the lateral and posterior parietal pleura). The anterior surface of the costoparietal pleura was excluded from analysis after interim review as this surface was rarely seen.
RESULTS
In the benign group, inflammation was the predominant finding in 65% (n = 33; costoparietal), 44% (n = 21; visceral), and 42% (n = 15; diaphragmatic). Nodules were detected in 24% (n = 12; costoparietal), 8% (n = 4; visceral), and 8% (n = 3; diaphragmatic). The most affected surfaces with inflammation were the middle lateral (60%) and the inferior lateral (57.8%) parts of the costoparietal pleura. In the malignant group, nodules were the predominant finding according to surface in 73% (n = 33; costoparietal), 32% (n = 13; visceral) and 48% (n = 17; diaphragmatic). Inflammation was detected in 44% (n = 20; costoparietal), 25% (n = 10; visceral), and 29% (n = 10; diaphragmatic). The most affected surfaces with nodules were the middle lateral (67.4%) and inferior lateral (66.7%) costoparietal pleural surfaces.
CONCLUSION
This is the first detailed, anatomical description of abnormalities in the pleural space during thoracoscopy. While nodules were the predominant pattern in malignant pleural effusion, they were detected in 24% of benign diagnoses. Detection of nodules in >1 area of the costoparietal pleura was in favor of a malignant diagnosis. Inflammation was the predominant pattern in benign pleural effusion. Our results suggest that macroscopic nodules in malignant diagnoses have a predilection for the middle and inferior surfaces of the lateral costoparietal pleura.
Topics: Humans; Inflammation; Lymphangitis; Pleura; Pleural Diseases; Pleural Effusion; Pleural Effusion, Malignant; Pleural Neoplasms; Thoracoscopy
PubMed: 34515216
DOI: 10.1159/000517910 -
Thoracic Surgery Clinics Nov 2020Extrapleural pneumonectomy (EPP) is the most extensive form of surgery for mesothelioma, involving en bloc resection of visceral and parietal pleura, lung, diaphragm and... (Review)
Review
Extrapleural pneumonectomy (EPP) is the most extensive form of surgery for mesothelioma, involving en bloc resection of visceral and parietal pleura, lung, diaphragm and pericardium, with reconstruction of the pericardium and diaphragm. It can be performed safely in carefully selected patients. It should be performed in experienced centers as part of a multimodality treatment plan. The SMART approach, with a short course of induction hemithoracic radiation followed by EPP has demonstrated safety and value of hypofractionated hemithoracic radiation combined with complete macroscopic resection. We are conducting a clinical trial with oligofractionated hemithoracic radiation in early-stage mesothelioma.
Topics: Combined Modality Therapy; Diaphragm; Humans; Lung; Mesothelioma, Malignant; Neoadjuvant Therapy; Pericardium; Pleura; Pleural Neoplasms; Pneumonectomy; Plastic Surgery Procedures
PubMed: 33012433
DOI: 10.1016/j.thorsurg.2020.08.004 -
Clinical Journal of Gastroenterology Feb 2022Pleural metastasis in rectal cancer is often due to secondary invasion or dissemination from intrapulmonary metastases. To date, there are no reports on solitary pleural...
Pleural metastasis in rectal cancer is often due to secondary invasion or dissemination from intrapulmonary metastases. To date, there are no reports on solitary pleural metastasis. Here, we report a rare case of lower rectal cancer that recurred as pleural metastasis 4 years after surgical resection of the primary tumor. He was a 65-year-old man who visited our department with an abnormal shadow on his chest X-ray. He had a history of lower rectal cancer and had undergone laparoscopic low anterior resection of the rectum and bilateral lymph node dissection after neoadjuvant chemotherapy. Pathological ypT3N1M0 stage IIIA tumor was diagnosed, and adjuvant chemotherapy was administered. According to the computed tomography scan, a pleural tumor or pulmonary metastasis was suspected. Thoracoscopic partial resection of the lung and a partial pleurectomy were performed for diagnostic and therapeutic purposes. Histopathological examination revealed a highly differentiated tubular adenocarcinoma, consistent with metastatic rectal cancer. The nodule arose from the visceral pleura and invaded the parietal pleura with few malignant cells in the lung parenchyma. The lesion was surgically resected. However, 3 months after the second surgery, tumor recurrence with pleural dissemination was observed, and chemotherapy was initiated.
Topics: Aged; Humans; Lymph Node Excision; Male; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Pleura; Rectal Neoplasms
PubMed: 34988881
DOI: 10.1007/s12328-021-01565-6 -
American Journal of Respiratory and... Feb 2017
Topics: Calcinosis; Female; Humans; Middle Aged; Pleura; Pleural Diseases; Radiography, Thoracic
PubMed: 27854506
DOI: 10.1164/rccm.201606-1265IM -
The Clinical Respiratory Journal Apr 2019The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and... (Review)
Review
The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.
Topics: Blister; Bronchiolitis; Chest Tubes; Disease Management; Humans; Male; Needles; Paracentesis; Pleura; Pleurodesis; Pneumothorax; Practice Guidelines as Topic; Pulmonary Emphysema; Recurrence; Risk Factors; Smoking; Talc; Thoracic Surgery, Video-Assisted; Thoracotomy
PubMed: 30615303
DOI: 10.1111/crj.12990 -
Seminars in Roentgenology Oct 2023
Topics: Humans; Pleura
PubMed: 37973266
DOI: 10.1053/j.ro.2023.07.003 -
International Journal of Molecular... Jan 2022Pleural injury and subsequent loculation is characterized by acute injury, sustained inflammation and, when severe, pathologic tissue reorganization. While fibrin... (Review)
Review
Pleural injury and subsequent loculation is characterized by acute injury, sustained inflammation and, when severe, pathologic tissue reorganization. While fibrin deposition is a normal part of the injury response, disordered fibrin turnover can promote pleural loculation and, when unresolved, fibrosis of the affected area. Within this review, we present a brief discussion of the current IPFT therapies, including scuPA, for the treatment of pathologic fibrin deposition and empyema. We also discuss endogenously expressed PAI-1 and how it may affect the efficacy of IPFT therapies. We further delineate the role of pleural mesothelial cells in the progression of pleural injury and subsequent pleural remodeling resulting from matrix deposition. We also describe how pleural mesothelial cells promote pleural fibrosis as myofibroblasts via mesomesenchymal transition. Finally, we discuss novel therapeutic targets which focus on blocking and/or reversing the myofibroblast differentiation of pleural mesothelial cells for the treatment of pleural fibrosis.
Topics: Animals; Disease Progression; Drug Delivery Systems; Fibrosis; Gene Expression Regulation; Humans; Plasminogen Activator Inhibitor 1; Pleura; Recombinant Proteins; Urokinase-Type Plasminogen Activator
PubMed: 35163509
DOI: 10.3390/ijms23031587 -
Respiratory Physiology & Neurobiology Jan 2016To verify the hypothesis that by enmeshing lubricants, microvilli reduce the coefficient of kinetic friction (μ) of pleural mesothelium, μ was measured during...
To verify the hypothesis that by enmeshing lubricants, microvilli reduce the coefficient of kinetic friction (μ) of pleural mesothelium, μ was measured during reciprocating sliding of rabbit's visceral against parietal pleura before and after addition of hyaluronan, and related to the morphological features of the microvillar network. Because no relation was found between μ or μ changes after hyaluronan and microvillar characteristics, the latter are not determinants of the frictional forces which oppose sliding of normal mesothelial surfaces under physiological conditions, nor of the effects of hyaluronan. Addition of hyaluronan increased μ slightly but significantly in normal specimens, probably by altering the physiological mix of lubricants, but decreased μ of damaged mesothelia, suggesting protective, anti-abrasion properties. Indeed, while sliding of an injured against a normal pleura heavily damaged the latter and increased μ when Ringer was interposed between the surfaces, both effects were limited or prevented when hyaluronan was interposed between the injured and normal pleura before onset of sliding.
Topics: Animals; Epithelium; Friction; Hyaluronic Acid; Isotonic Solutions; Lubricants; Microscopy, Electron, Transmission; Microvilli; Pleura; Rabbits; Respiration; Ringer's Solution
PubMed: 26376001
DOI: 10.1016/j.resp.2015.09.003 -
Thoracic Surgery Clinics Nov 2014Although originally performed on patients with refractory tuberculosis and malignant pleural mesothelioma, extrapleural pneumonectomy may be used to treat patients with... (Review)
Review
Although originally performed on patients with refractory tuberculosis and malignant pleural mesothelioma, extrapleural pneumonectomy may be used to treat patients with pleural dissemination of other malignancies, including thymoma and NSCLC. Patients who present with stage IV NSCLC caused by malignant pleural effusion may be considered for EPP following induction chemotherapy if they demonstrate no mediastinal nodal or distant metastases and have adequate cardiopulmonary reserve. EPP for NSCLC should be performed by experienced teams at experienced centers to minimize the morbidity and mortality associated with this radical procedure. Additional prospective studies are needed to better characterize the role of EPP in the multimodality treatment of patients with pleural dissemination of malignancy, including NSCLC.
Topics: Humans; Pleura; Pleural Neoplasms; Pneumonectomy
PubMed: 25441141
DOI: 10.1016/j.thorsurg.2014.07.014