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Respirology (Carlton, Vic.) Jul 2020
Topics: Biomarkers; Humans; Lung; Pleural Effusion, Malignant; Pleurodesis; Talc
PubMed: 31945800
DOI: 10.1111/resp.13765 -
Thorax Apr 2023
Topics: Humans; Artificial Intelligence; Pleural Effusion; Pleural Effusion, Malignant; Diagnosis, Differential
PubMed: 36456180
DOI: 10.1136/thorax-2022-219608 -
Chest Dec 2020There is an evolution of pleural procedures that involve broadened clinical indication and expanded scope that include advanced diagnostic, therapeutic, and palliative... (Review)
Review
There is an evolution of pleural procedures that involve broadened clinical indication and expanded scope that include advanced diagnostic, therapeutic, and palliative procedures. Finance and clinical professionals have been challenged to understand the indication and coding complexities that accompany these procedures. This article describes the utility of pleural procedures, the appropriate current procedural terminology coding, and necessary modifiers. Coding pearls that help close the knowledge gap between basic and advanced procedures aim to address coding confusion that is prevalent with pleural procedures and the risk of payment denials, potential underpayment, and documentation audits.
Topics: Current Procedural Terminology; Diagnostic Techniques and Procedures; Humans; Pleural Diseases; Pulmonary Medicine; Relative Value Scales; Thoracic Surgical Procedures
PubMed: 32882245
DOI: 10.1016/j.chest.2020.08.2070 -
European Journal of Cardio-thoracic... Dec 2020Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During...
OBJECTIVES
Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During the pandemic, several complications have been shown to be associated with coronavirus disease 2019 (COVID-19). Our goal was to present a series of patients with COVID-19 who underwent chest tube placements due to the development of pleural complications and to make suggestions for the insertion and follow-up management of the chest tube.
METHODS
We retrospectively collected and analysed data on patients with laboratory-confirmed COVID-19 in our hospital between 11 March and 15 May 2020. Patients from this patient group who developed pleural complications requiring chest tube insertion were included in the study.
RESULTS
A total of 542 patients who were suspected of having COVID-19 were hospitalized. The presence of severe acute respiratory syndrome coronavirus 2 was confirmed with laboratory tests in 342 patients between 11 March and 15 May 2020 in our centre. A chest tube was used in 13 (3.8%) of these patients. A high-efficiency particulate air filter mounted double-bottle technique was used to prevent viral transmission.
CONCLUSIONS
In patients with COVID-19, the chest tube can be applied in cases with disease or treatment-related pleural complications. Our case series comprised a small group of patients, which is one of its limitations. Still, our main goal was to present our experience with patients with pleural complications and describe a new drainage technique to prevent viral transmission during chest tube application and follow-up.
Topics: Aftercare; Aged; COVID-19; Chest Tubes; Cross Infection; Drainage; Female; Follow-Up Studies; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Male; Middle Aged; Pandemics; Patient Safety; Pleural Diseases; Retrospective Studies; Treatment Outcome; Turkey
PubMed: 33164094
DOI: 10.1093/ejcts/ezaa356 -
Seminars in Respiratory and Critical... Aug 2022Pleural malignancies are among the most common causes of pleural disease and form the basis of our daily pleural practice. There has been significant research and...
Pleural malignancies are among the most common causes of pleural disease and form the basis of our daily pleural practice. There has been significant research and increase in both diagnostic and therapeutic management of malignant pleural diseases in the last decade. Good-quality data have led to a paradigm shift in the management options of pleural malignancies, and indwelling pleural catheter is now recommended and widely used as first-line intervention. Several trials compared different treatment modalities for pleural malignancies and continue to emphasize the need to reduce hospital length of stay and unnecessary pleural intervention, and the importance of patient choice in clinical decision making. This practical review aims to summarize the current knowledge for the management of pleural malignancies, and the understanding of the steps that we still have to climb to optimize management and reduce morbidity.
Topics: Catheterization; Catheters, Indwelling; Drainage; Humans; Pleural Effusion, Malignant; Pleurodesis
PubMed: 35613947
DOI: 10.1055/s-0042-1748185 -
Postgraduate Medical Journal Jun 2023The incidence of pleural disease is increasing, and pleural medicine is increasingly recognised as a subspecialty within respiratory medicine. This often requires...
The incidence of pleural disease is increasing, and pleural medicine is increasingly recognised as a subspecialty within respiratory medicine. This often requires additional training time. Once underresearched, the last decade has seen an explosion in evidence related to the management of pleural disease. One of the cornerstones of pleural effusion management is the insertion of an indwelling pleural catheter. This allows patient-centred outpatient management and now has a robust evidence base. This article summarises evidence as well serves as a practical guide to the management of any complications related to an indwelling pleural catheter that might present on an acute take.
Topics: Humans; Pleural Effusion, Malignant; Catheters, Indwelling; Pleural Diseases; Pleural Effusion; Drainage
PubMed: 37294731
DOI: 10.1136/postgradmedj-2021-141200 -
Thorax Nov 2021Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. Our aim was to study the epidemiology of pleural empyema on a...
BACKGROUND
Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. Our aim was to study the epidemiology of pleural empyema on a nationwide basis in the whole population and in three subgroups of patients, namely post-lung resection, associated cancer and those with no surgery and no cancer.
METHODS
Data from patients aged ≥18 years hospitalised with a diagnosis of pleural infection in France between January 2013 and December 2017 were retrieved from the medical-administrative national hospitalisation database and retrospectively analysed. Mortality, length of stay and costs were assessed.
RESULTS
There were 25 512 hospitalisations for pleural empyema. The annual rate was 7.15 cases per 100 000 habitants in 2013 and increased to 7.75 cases per 100 000 inhabitants in 2017. The mean age of patients was 62.4±15.6 years and 71.7% were men. Post-lung resection, associated cancer and no surgery-no cancer cases accounted for 9.8%, 30.1% and 60.1% of patients, respectively. These groups were significantly different in terms of clinical characteristics, mortality and risk factors for length of stay, costs and mortality. Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery-no cancer group. In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status 3 and three subgroups of pleural empyema independently predicted mortality.
CONCLUSIONS
Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.
Topics: Adolescent; Adult; Aged; Empyema, Pleural; Humans; Incidence; Male; Middle Aged; Pleural Diseases; Prognosis; Retrospective Studies
PubMed: 33785584
DOI: 10.1136/thoraxjnl-2020-215267 -
Radiologia 2022Melioidosis is an endemic disease in Southeast Asia and Oceania caused by the gram-negative bacillus Burkholderia pseudomallei. We studied 15 adult patients from... (Review)
Review
Melioidosis is an endemic disease in Southeast Asia and Oceania caused by the gram-negative bacillus Burkholderia pseudomallei. We studied 15 adult patients from Colombia with microbiologically diagnosed pulmonary melioidosis. We reviewed 15 chest X-rays and 10 chest computed tomography (CT) studies. Of the 15 patients, 87% met the criteria for acute infection and 13% met the criteria for chronic infection. The most common findings on chest X-rays were consolidation (86%), nodules (26%), and cavitation (20%). On CT studies, consolidation and nodules were observed in 90% of cases; the areas of consolidation were predominantly located in the basal and central zones in 60%. Areas of cavitation were observed in 50%, pleural effusion in 60%, and mediastinal lymph nodes in 30%. In patients with acute pulmonary melioidosis (n=8), the findings observed were nodules (100%), mixed pattern with nodules and consolidation (87%), pleural effusion (88%), and mediastinal lymph nodes (25%). The two patients with chronic pulmonary melioidosis both had cavitation. Acute lung infection with B. Pseudomallei has radiologic manifestations similar to those of pneumonia due to other causes. In areas where the disease is endemic, it is essential to include acute melioidosis in the differential diagnosis of pulmonary nodules and chronic melioidosis in the differential diagnosis of cavitated chronic lung lesions.
Topics: Adult; Burkholderia pseudomallei; Humans; Lung Diseases; Melioidosis; Pleural Effusion; Pneumonia; Tuberculosis, Pleural
PubMed: 36243448
DOI: 10.1016/j.rxeng.2022.09.002 -
Expert Review of Respiratory Medicine 2023Real-time thoracic ultrasound-guided pleural biopsy (TUSPB) is an important diagnostic method for pleural diseases. Traditional two-dimensional thoracic ultrasound, as... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Real-time thoracic ultrasound-guided pleural biopsy (TUSPB) is an important diagnostic method for pleural diseases. Traditional two-dimensional thoracic ultrasound, as well as newly developed contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE), are all used as guidance tools for pleural biopsies. Herein, we aimed to determine the diagnostic yield of real-time TUSPB for pleural diseases to better inform the decision-making process.
METHODS
A literature search of the MEDLINE/PubMed, Embase, and Cochrane Library databases was performed up to June 2023. A binary random-effects model was applied to determine the pooled diagnostic yield.
RESULTS
Fifteen studies comprising 1553 patients with pleural diseases were included and analyzed. The overall diagnostic yield of TUSPB for pleural diseases was 85.58% (95% confidence interval [CI]: 81.57-89.58%). The sensitivity was 77.56% for pleural malignancy and 80.13% for tuberculous pleurisy. The sub-analysis result revealed that CEUS-guided pleural biopsy provided a pooled diagnostic yield of 98.24%, which was higher than that of conventional TUSPB (78.97%; < 0.01). The overall proportion of adverse events for TUSPB was 6.68% (95% CI: 5.31-8.04%).
CONCLUSION
Conventional TUSPB has good pooled diagnostic yields and high safety. CEUS and UE are promising guidance tools for pleural biopsy with the potential to increase diagnostic yield.
Topics: Humans; Pleura; Ultrasonography; Image-Guided Biopsy; Tuberculosis, Pleural; Ultrasonography, Interventional
PubMed: 37787485
DOI: 10.1080/17476348.2023.2266377 -
European Respiratory Review : An... Dec 2019Focused thoracic ultrasound has become essential in the guidance and direction of pleural interventions to reduce unwanted complications and as a result now forms a... (Review)
Review
Focused thoracic ultrasound has become essential in the guidance and direction of pleural interventions to reduce unwanted complications and as a result now forms a crucial component of physician training. Current training standards along with assessment methods vary widely, and are often not robust enough to ensure adequate competence.This review assesses the current state of training and assessment of thoracic ultrasound competence in various settings, allowing comparison with alternative competency based programmes. Future directions for training and assessment of thoracic ultrasound competence are discussed.
Topics: Clinical Competence; Echocardiography, Doppler; Female; Humans; Male; Pleural Diseases; Surgery, Computer-Assisted; Thoracic Surgical Procedures; Ultrasonography, Doppler
PubMed: 31871126
DOI: 10.1183/16000617.0090-2019