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Current Opinion in Pulmonary Medicine Mar 2023Exposure to asbestos can cause both benign and malignant, pulmonary and pleural diseases. In the current era of low asbestos exposure, it is critical to be aware of... (Review)
Review
PURPOSE OF REVIEW
Exposure to asbestos can cause both benign and malignant, pulmonary and pleural diseases. In the current era of low asbestos exposure, it is critical to be aware of complications from asbestos exposure; as they often arise after decades of exposure, asbestos-related pulmonary complications include asbestosis, pleural plaques, diffuse pleural thickening, benign asbestos-related pleural effusions and malignant pleural mesothelioma.
RECENT FINDINGS
Multiple recent studies are featured in this review, including a study evaluating imaging characteristics of asbestos with other fibrotic lung diseases, a study that quantified pleural plaques on computed tomography imaging and its impact on pulmonary function, a study that examined the risk of lung cancer with pleural plaques among two large cohorts and a review of nonasbestos causes of malignant mesothelioma.
SUMMARY
Asbestos-related pulmonary and pleural diseases continue to cause significant morbidity and mortality. This review summarizes the current advances in this field and highlights areas that need additional research.
Topics: Humans; Mesothelioma; Asbestos; Pleural Diseases; Lung Diseases; Asbestosis; Pleural Effusion; Lung Neoplasms; Mesothelioma, Malignant
PubMed: 36630203
DOI: 10.1097/MCP.0000000000000939 -
RoFo : Fortschritte Auf Dem Gebiete Der... Oct 2019High diagnostic accuracy, increasing clinical experience and technical improvements are good reasons to consider lung ultrasound (US) for the assessment of pleural... (Review)
Review
BACKGROUND
High diagnostic accuracy, increasing clinical experience and technical improvements are good reasons to consider lung ultrasound (US) for the assessment of pleural and pulmonary diseases. In the emergency room and in intensive care, it is well acknowledged, but application in other settings is rare. The aim of this review is to update potential users in general radiology about the diagnostic scope of lung US and to encourage more frequent use of this generally underestimated lung imaging modality.
METHOD
Literature review was done independently by the two authors in MEDLINE (via PubMed) covering a time span from 2002 until 2017 using free text and Medical Subject Headings/MeSH. Article selection for the bibliography was based on consensus according to relevance and evidence.
RESULTS AND CONCLUSION
The technical prerequisites include a standard ultrasound unit with a suitable transducer. Pleural effusion and pneumothorax, atelectasis, interstitial edema, pneumonia, exacerbated chronic obstructive pulmonary disease/asthma and pulmonary embolism can be distinguished by particular ultrasound signs, artifacts and their combinations. A highly standardized selection of access points and terminology for the description of imaging findings contributes to high diagnostic accuracy even in challenging patients and settings. Besides the assessment of acute respiratory failure in the emergency room, lung US may be used for monitoring interstitial fluid accumulation in volume therapy and for the diagnosis of pneumonia or the assessment of pleural effusion and pleurisy in a routine outpatient setting. Last but not least, the increasing concerns about medical radiation exposure warrant a more extensive use of this sometimes underestimated modality as a cost-, time- and radiation-saving alternative or valuable adjunct to the standard imaging modalities.
KEY POINTS
· Lung US is a safe, quick and readily available method with options for dynamic imaging of respiratory function.. · Proper selection of technical parameters customized to the clinical question and standardized terminology for the precise description and interpretation of the imaging signs regarding patient history determine its diagnostic accuracy.. · In dyspnea lung US differentiates pneumothorax, lung edema, pneumonia, pulmonary embolism, atelectasis and pleural effusion.. · In intensive care, lung US allows monitoring of lung ventilation and fluid administration.. · It saves radiation exposure in serial follow-up, in pregnancy and pediatric radiology..
CITATION FORMAT
· Radzina M, Biederer J, Ultrasonography of the Lung. Fortschr Röntgenstr 2019; 191: 909 - 923.
Topics: Acute Disease; Chronic Disease; Humans; Lung; Lung Diseases; Pleural Diseases; Point-of-Care Testing; Pulmonary Embolism; Thoracic Wall; Ultrasonography
PubMed: 30947352
DOI: 10.1055/a-0881-3179 -
Thorax Jul 2023
Topics: Humans; Pleural Diseases
PubMed: 37433578
DOI: 10.1136/thorax-2022-219784 -
JSLS : Journal of the Society of... 2019Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%-10% of reproductive-age... (Review)
Review
BACKGROUND
Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%-10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES).
DATABASE
Computerized searches of MEDLINE and PubMed were conducted using the key words "thoracic endometriosis," "catamenial pneumothorax," "catamenial hemothorax," and "catamenial hemoptysis." References from identified sources were manually searched to allow for a thorough review.
CONCLUSION
TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence.
Topics: Adult; Diaphragm; Endometriosis; Female; Hemothorax; Humans; Laparoscopy; Pleural Diseases; Pneumothorax; Recurrence; Thoracic Diseases; Thoracic Surgery, Video-Assisted
PubMed: 31427853
DOI: 10.4293/JSLS.2019.00029 -
Critical Care Medicine Feb 2021To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of... (Review)
Review
OBJECTIVE
To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of positive-pressure ventilation. To provide guidance of lung isolation, mechanical ventilator, pleural catheter, and endobronchial strategies for the management of bronchopleural fistula on mechanical ventilation.
DATA SOURCES
Online search of PubMed and manual review of articles (laboratory and patient studies) was performed.
STUDY SELECTION
Articles relevant to bronchopleural fistula, mechanical ventilation in patients with bronchopleural fistula, independent lung ventilation, high-flow ventilatory modes, physiology of persistent air leak, extracorporeal membrane oxygenation, fluid dynamics of bronchopleural fistula airflow, and intrapleural catheter management were selected. Randomized trials, observational studies, case reports, and physiologic studies were included.
DATA EXTRACTION
Data from selected studies were qualitatively evaluated for this review. We included data illustrating the physiology of driving pressure across a bronchopleural fistula as well as data, largely from case reports, demonstrating management and outcomes with various ventilator modes, intrapleural catheter techniques, endoscopic placement of occlusion and valve devices, and extracorporeal membrane oxygenation. Themes related to managing persistent air leak with mechanical ventilation were reviewed and extracted.
DATA SYNTHESIS
In case reports that demonstrate different approaches to managing patients with bronchopleural fistula requiring mechanical ventilation, common themes emerge. Strategies aimed at decreasing peak inspiratory pressure, using lower tidal volumes, lowering positive end-expiratory pressure, decreasing the inspiratory time, and decreasing the respiratory rate, while minimizing negative intrapleural pressure decreases airflow across the bronchopleural fistula.
CONCLUSIONS
Mechanical ventilation and intrapleural catheter management must be individualized and aimed at reducing air leak. Clinicians should emphasize reducing peak inspiratory pressures, reducing positive end-expiratory pressure, and limiting negative intrapleural pressure. In refractory cases, clinicians can consider lung isolation, independent lung ventilation, or extracorporeal membrane oxygenation in appropriate patients as well as definitive management with advanced bronchoscopic placement of valves or occlusion devices.
Topics: Bronchial Fistula; Female; Humans; Male; Pleural Diseases; Positive-Pressure Respiration; Ventilators, Mechanical
PubMed: 33372747
DOI: 10.1097/CCM.0000000000004771 -
Cancer Discovery Nov 2021Malignant pleural diseases, comprising metastatic lung and breast cancers and malignant pleural mesothelioma (MPM), are aggressive solid tumors with poor therapeutic...
Malignant pleural diseases, comprising metastatic lung and breast cancers and malignant pleural mesothelioma (MPM), are aggressive solid tumors with poor therapeutic response. We developed and conducted a first-in-human, phase I study of regionally delivered, autologous, mesothelin-targeted chimeric antigen receptor (CAR) T-cell therapy. Intrapleural administration of 0.3M to 60M CAR T cells/kg in 27 patients (25 with MPM) was safe and well tolerated. CAR T cells were detected in peripheral blood for >100 days in 39% of patients. Following our demonstration that PD-1 blockade enhances CAR T-cell function in mice, 18 patients with MPM also received pembrolizumab safely. Among those patients, median overall survival from CAR T-cell infusion was 23.9 months (1-year overall survival, 83%). Stable disease was sustained for ≥6 months in 8 patients; 2 exhibited complete metabolic response on PET scan. Combination immunotherapy with CAR T cells and PD-1 blockade agents should be further evaluated in patients with solid tumors. SIGNIFICANCE: Regional delivery of mesothelin-targeted CAR T-cell therapy followed by pembrolizumab administration is feasible, safe, and demonstrates evidence of antitumor efficacy in patients with malignant pleural diseases. Our data support the investigation of combination immunotherapy with CAR T cells and PD-1 blockade agents in solid tumors...
Topics: Antibodies, Monoclonal, Humanized; Humans; Immunotherapy, Adoptive; Mesothelin; Mesothelioma; Pleural Diseases
PubMed: 34266984
DOI: 10.1158/2159-8290.CD-21-0407 -
Thorax Nov 2023
Topics: Humans; Pleural Diseases; Pleural Effusion
PubMed: 37553157
DOI: 10.1136/thorax-2023-220304 -
Seminars in Respiratory and Critical... Aug 2023Coronavirus disease 2019 (COVID-19)-related pleural diseases are now well recognized. Since the beginning of the pandemic, increasing cases of pleural diseases including...
Coronavirus disease 2019 (COVID-19)-related pleural diseases are now well recognized. Since the beginning of the pandemic, increasing cases of pleural diseases including pneumothorax, pneumomediastinum, and pleural effusion with severe COVID-19 infection have attracted the attention of physicians and are not incidental or due to barotrauma. The complicated course of COVID-19 illness highlights the complex pathophysiological underpinnings of pleural complications. The management of patients with pneumothorax and pneumomediastinum is challenging as the majority require assisted ventilation; physicians therefore appear to have a low threshold to intervene. Conversely, pleural effusion cases, although sharing some similar patient characteristics with pneumothorax and pneumomediastinum, are in general managed more conservatively. The evidence suggests that patients with COVID-19-related pleural diseases, either due to air leak or effusion, have more severe disease with a worse prognosis. This implies that prompt recognition of these complications and targeted management are key to improve outcomes.
Topics: Humans; Pneumothorax; COVID-19; Mediastinal Emphysema; Pleural Diseases; Pleural Effusion
PubMed: 37429295
DOI: 10.1055/s-0043-1769616 -
Clinics in Chest Medicine Dec 2021Medical thoracoscopy is an effective and safe modality to visualize and sample contents of the pleural cavity. It is an outpatient procedure that can be performed while... (Review)
Review
Medical thoracoscopy is an effective and safe modality to visualize and sample contents of the pleural cavity. It is an outpatient procedure that can be performed while the patient is spontaneously breathing, with the use of local anesthesia and intravenous medications for sedation and analgesia. Medical thoracoscopy has indications in the management of a variety of pleural diseases. It is most commonly performed as a diagnostic procedure but has therapeutic applications as well. Although it has its advantages, management strategies of certain pleural diseases should take place within a multidisciplinary environment including general pulmonologists, interventional pulmonologists, and thoracic surgeons.
Topics: Humans; Pleural Diseases; Pleural Effusion; Thoracoscopy
PubMed: 34774180
DOI: 10.1016/j.ccm.2021.08.010 -
Thorax Nov 2023
Topics: Humans; Pleural Diseases; Empyema, Pleural
PubMed: 37848216
DOI: 10.1136/thorax-2022-219630