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American Journal of Respiratory and... Jan 2020
Topics: Asbestos; Humans; Lung Neoplasms; Pleural Diseases
PubMed: 31539279
DOI: 10.1164/rccm.201908-1676ED -
Seminars in Respiratory and Critical... Jun 2024Connective tissue diseases (CTD) are heterogeneous, immune-mediated inflammatory disorders often presenting with multiorgan involvement. With the advent of... (Review)
Review
Connective tissue diseases (CTD) are heterogeneous, immune-mediated inflammatory disorders often presenting with multiorgan involvement. With the advent of high-resolution computed tomography, CTD-related pleuritis-pleural thickening and effusion-is now increasingly recognized early in the disease trajectory. The natural history of CTD-related pleural effusions varies from spontaneous resolution to progressive fibrothorax with ventilatory impairment. Treatment of the underlying CTD is necessary to manage the pleural disease. Depending on the degree of symptom burden and physiological insult, specific treatment of pleural disease can include monitoring, repeated aspirations, systemic anti-inflammatory medication, and surgical decortication.
Topics: Humans; Connective Tissue Diseases; Pleural Diseases; Tomography, X-Ray Computed; Pleural Effusion; Pleurisy; Anti-Inflammatory Agents; Disease Progression
PubMed: 38547917
DOI: 10.1055/s-0044-1782612 -
Expert Review of Respiratory Medicine Oct 2020Developing a feasible and accurate means of evaluating pleural pathology has been an ongoing effort for over 150 years. Pleural fluid cellular and biomarker analyses... (Review)
Review
INTRODUCTION
Developing a feasible and accurate means of evaluating pleural pathology has been an ongoing effort for over 150 years. Pleural fluid cellular and biomarker analyses are simple ways of characterizing and uncovering pathologic entities of pleural disease. However, obtaining samples of pleural tissue has become increasingly important. In cases of suspected malignancy and certain infections histopathology, culture, and molecular testing are necessary to profile diseases more effectively. The pleura is sampled via several techniques including blind transthoracic biopsy, image-guided biopsy, and surgical thoracotomy. Given the heterogeneity of pleural disease, low diagnostic yields, or invasiveness no procedural gold standard has been established in pleural diagnostics.
AREAS COVERED
Herein, we provide a review of the literature on medical thoracoscopy (MT), its development, technical approach, indications, risks, current and future role in the evaluation of thoracic disease. Pubmed was searched for articles published on MT, awake thoracoscopy, and pleuroscopy with a focus on reviewing literature published in the past 5 years.
EXPERT OPINION
As the proficiency and number of interventional pulmonologists continues to grow, MT is ideally positioned to become a front-line diagnostic tool in pleural disease and play an increasingly prominent role in the treatment algorithm of various pleural pathologies.
Topics: Humans; Pleural Diseases; Practice Guidelines as Topic; Thoracoscopy
PubMed: 32588676
DOI: 10.1080/17476348.2020.1788940 -
Respirology (Carlton, Vic.) Sep 2020Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of... (Review)
Review
Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of recent clinical trials have provided an evidence-based platform to evaluate conventional and novel methods to drain pleural effusions/air which reduce morbidity and unnecessary interventions. These successes have generated significant enthusiasm and raised the profile of pleural medicine as a new subspecialty. The ultimate goal of pleural research is to prevent/stop development of pleural effusions/pneumothorax. Current research studies mainly focus on the technical aspects of pleural drainage. Significant knowledge gaps exist in many aspects such as understanding of the pathobiology of the underlying pleural diseases, pharmacokinetics of pleural drug delivery, etc. Answers to these important questions are needed to move the field forward. This article collates opinions of leading experts in the field in highlighting major knowledge gaps in common pleural diseases to provoke thinking beyond pleural drainage. Recognizing the key barriers will help prioritize future research in the quest to ultimately cure (rather than just drain) these pleural conditions.
Topics: Biomedical Research; Drainage; Expert Testimony; Humans; Mesothelioma; Pleural Effusion; Pleural Effusion, Malignant; Pleural Neoplasms; Pneumothorax
PubMed: 32613624
DOI: 10.1111/resp.13881 -
Indian Journal of Pediatrics Sep 2019Chest radiographs and CT scans have been the cornerstone of pulmonary imaging given their advantages of being rapid and easily available techniques. However, a... (Review)
Review
Chest radiographs and CT scans have been the cornerstone of pulmonary imaging given their advantages of being rapid and easily available techniques. However, a significant concern with their use in the pediatric population is the associated ionisation radiation. The use of magnetic resonance imaging (MRI) in pulmonary imaging has lagged behind its adoption in other organ systems. Previously, the lung parenchyma was considered difficult to evaluate by magnetic resonance due to low proton density in the pulmonary tissue, susceptibility artefacts within the lungs, and respiratory motion artefacts. However, in recent years, there have been a multitude of technical advancements to overcome these limitations. MRI can be an excellent radiation-free alternative in patients who require protracted follow-up like in cases such as cystic fibrosis, complicated pneumonias, tuberculosis and mediastinal neoplasms. An added advantage of MRI is that it can provide functional information in addition to the structural information provided by traditional imaging techniques. One of the major reasons of limited use of MRI despite its established utility is the lack of clarity regarding its indications, and a paucity of data on tailored MRI protocols customised to clinical needs. This article aims to review the basic MRI techniques, indications and terminologies used in chest imaging, with special emphasis on imaging findings of common pathologies in the pediatric population.
Topics: Adolescent; Child; Cystic Fibrosis; Diagnostic Imaging; Humans; Lung; Magnetic Resonance Imaging; Mediastinal Neoplasms; Neoplasms; Parenchymal Tissue; Pediatrics; Pleural Diseases; Pneumonia; Thorax; Tomography, X-Ray Computed; Tuberculosis
PubMed: 30719641
DOI: 10.1007/s12098-018-02852-w -
Acta Radiologica (Stockholm, Sweden :... Feb 2023Anatomical variants and imaging artifacts on thoracic computed tomography (CT), when unrecognized as such, can lead to radiological misinterpretation and erroneous... (Review)
Review
Anatomical variants and imaging artifacts on thoracic computed tomography (CT), when unrecognized as such, can lead to radiological misinterpretation and erroneous diagnosis. This is a concise review of 15 common CT diagnostic pitfalls due to anatomical variants and imaging artifacts which have potential to be misinterpreted as significant pathology, such as neoplasia, infection, traumatic injury, interstitial lung disease, pleural disease, or vascular lesions.
Topics: Humans; Tomography, X-Ray Computed; Thorax; Neoplasms; Pleural Diseases
PubMed: 35171051
DOI: 10.1177/02841851221080011 -
Seminars in Nuclear Medicine Nov 2022Malignant mesothelioma is an aggressive tumor originating from the mesothelial cells and presenting in general with a very poor prognosis. The pleural localization... (Review)
Review
Malignant mesothelioma is an aggressive tumor originating from the mesothelial cells and presenting in general with a very poor prognosis. The pleural localization represents the prevailing disease site, while peritoneal involvement is commonly rare. The WHO classifies mesotheliomas into epithelioid, biphasic, and sarcomatoid histotypes, having diverse outcome with the sarcomatoid or biphasic forms showing the poorest prognosis. Given the peculiar rind-like pattern of growth, mesothelioma assessment is rather challenging for medical imagers. Conventional imaging is principally based on contrast-enhanced CT, while the role of functional and metabolic imaging is regarded as complementary. By focusing essentially on the staging and restaging role of [18F]FDG PET/CT in malignant mesotheliomas, the present review will summarize the available data present in literature and provide some hints on alternative imaging and future perspectives. Given the prevailing incidence of pleural disease, the majority of the information will be addressed on malignant pleural mesothelioma, although a summary of principal characteristics and imaging findings in patients with peritoneal mesothelioma will be also provided.
Topics: Humans; Mesothelioma, Malignant; Pleural Neoplasms; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Mesothelioma
PubMed: 35965111
DOI: 10.1053/j.semnuclmed.2022.07.005 -
Respiratory Medicine Apr 2021Nitric oxide (NO) regulates various physiological and pathophysiological functions in the lungs. However, there is much less information about the effects of NO in the... (Review)
Review
Nitric oxide (NO) regulates various physiological and pathophysiological functions in the lungs. However, there is much less information about the effects of NO in the pleura. The present review aimed to explore the available evidence regarding the role of NO in pleural disease. NO, has a double-edged role in the pleural cavity. It is an essential signaling molecule mediating various physiological cell functions such as lymphatic drainage of the serous cavities, the immune response to intracellular multiplication of pathogens, and downregulation of neutrophil migration, but also induces genocytotoxic and mutagenic effects when present in excess. NO is implicated in the pathogenesis of asbestos-related or exudative pleural disease and mesothelioma. From a clinical point of view, the fraction of exhaled NO has been suggested as a potential non-invasive tool for the diagnosis of benign asbestos-related disorders. Under experimental conditions, NO-mimetics were found to attenuate hypoxia-induced therapy resistance in mesothelioma. Similarly, hybrid agents consisting of an NO donor coupled with a parent anti-inflammatory drug showed an enhancement of the anti-inflammatory activity of anti-inflammatory drugs. However, given the paucity of research work performed over the last years in this area, further research should be undertaken to establish reliable conclusions with respect to the feasibility of determining or targeting the NO signaling pathway for pleural disease diagnosis and therapeutic management.
Topics: Anti-Inflammatory Agents; Asbestos; Biomarkers; Humans; Mesothelioma; Nitric Oxide; Nitric Oxide Donors; Pleura; Pleural Diseases; Signal Transduction
PubMed: 33662805
DOI: 10.1016/j.rmed.2021.106350 -
Chest May 2022Pleural disease is a common presentation and spans a heterogeneous population across broad disease entities; a common feature is the requirement for interventional... (Review)
Review
Pleural disease is a common presentation and spans a heterogeneous population across broad disease entities; a common feature is the requirement for interventional procedures. Despite the frequency of such procedures, there is little consensus on rates of complications and risk factors associated with such complications. This narrative review was based on a structured search of the literature. Searches were limited to 2010 onward, in recognition of the transformation in procedural complications following the mainstream use of thoracic ultrasound. Procedures of interest were limited to thoracocentesis, intercostal drains, indwelling pleural catheters (IPCs), and local anesthetic thoracoscopy. A total of 4,308 studies were screened, and 48 studies were identified for inclusion. Iatrogenic pneumothorax remains the most common complication following thoracocentesis (3.3%; 95% CI, 3.2-3.4), although pneumothorax requiring intervention was rare (0.3%; 95% CI, 0.2-0.4) when the procedure was ultrasound guided. Drain blockage and displacement were the most common complications following intercostal drain insertion (6.3% and 6.8%, respectively). IPC-related infections can be a significant problem (5.8%; 95% CI, 5.1-6.7). However, most cases can be managed without removal of the IPC. Local anesthetic thoracoscopy has an overall mortality of 0.1% (95% CI, 0.03-0.3). Data on safety and complication rates in procedural interventions are limited by methodologic problems, and novel methods to study this topic should be considered. Although complications remain rare events, once encountered, they have the potential to rapidly escalate. It is of paramount importance for operators to prepare and have in place plans for such events to ensure high quality and, above all, safe care.
Topics: Anesthetics, Local; Catheters, Indwelling; Chest Tubes; Humans; Pleural Effusion, Malignant; Pneumothorax; Risk Factors
PubMed: 34896096
DOI: 10.1016/j.chest.2021.11.031 -
Clinics in Chest Medicine Dec 2021
Topics: Humans; Pleural Diseases
PubMed: 34774182
DOI: 10.1016/j.ccm.2021.08.013