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Ultraschall in Der Medizin (Stuttgart,... Dec 2023The CME review is intended to explain and discuss the clinical value of lung ultrasound but also to enable a pragmatically oriented approach by analyzing the clinical...
The CME review is intended to explain and discuss the clinical value of lung ultrasound but also to enable a pragmatically oriented approach by analyzing the clinical aspect. This includes knowledge of the pre-test probability, the acuteness of the disease, the current clinical situation, detection and/or characterization, initial diagnosis or follow up assessment and the peculiarities of exclusion diagnosis. Diseases of the pleura and lungs are described using these criteria with their direct and indirect sonographic signs and the specific clinical significance of ultrasound findings. The importance and criteria of conventional B-mode, color Doppler ultrasound with or without spectral analysis of the Doppler signal and contrast-enhanced ultrasound are discussed as well.
Topics: Humans; Lung; Ultrasonography; Pleura; Ultrasonography, Doppler, Color; Thorax
PubMed: 37054729
DOI: 10.1055/a-2010-7282 -
Zentralblatt Fur Chirurgie Feb 2021A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then,...
A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then, depending on several parameters, leads to a slight or clinically threatening impairment of lung function. Non-specific signs such as thoracic pain or coughing are common and do not correlate with the extent of the pneumothorax. Almost without exception, the cause of this accumulation of air is a leakage in the lung's surface, which then results in air escaping into the pleural space. Depending on the cause of the "lung leakage", a distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP) that can be triggered without direct cause, and a secondary spontaneous pneumothorax (SSP) in case of an underlying known lung disease. Further between an iatrogenic pneumothorax in connection with a lung injury caused by medical measures, and a traumatic pneumothorax in the case of an accident-related lung tear. The relevant therapeutic goals are the elimination of the acute symptoms, the reliable achievement of re-expansion of the lungs, and, after appropriate information gathering about the probability and clinical significance of a pneumothorax recurrence and depending on the patient's wish, avoiding a recurrence by means of surgical measures. The therapy options range from a "wait-and-see" procedure, that merely monitors the findings, to a primary video-assisted thoracoscopic surgical therapy with detection and resection of the superficial lung lesion, as well as a measurement to obliterate the pleural cavity that prevents relapse. Regarding "follow-up care" or even behavioral recommendations after a pneumothorax, there are no recommendations that reduce the risk of recurrence.
Topics: Humans; Lung Diseases; Pleura; Pneumothorax; Recurrence; Thoracic Surgery, Video-Assisted
PubMed: 33588508
DOI: 10.1055/a-1256-6008 -
The Indian Journal of Tuberculosis Jan 2022Pleural effusions despite being so common, there is no much literature available regarding definite diagnosis for pleural effusions. Application of Light's criteria... (Review)
Review
Pleural effusions despite being so common, there is no much literature available regarding definite diagnosis for pleural effusions. Application of Light's criteria changed the approach to pleural effusion and till date remains a very useful step in the diagnosis of pleural effusions. Pleural fluid biochemistry and adenosine deaminase (ADA) enzyme levels play a significant role in the diagnosis of tubercular effusion. Studies have shown that levels of ADA are more often higher in tubercular effusion than in any other cause for it. But ADA levels can also be elevated in other types of parapneumonic effusions (PPEs), especially complicated PPEs. Hence it is difficult to distinguish a tubercular pleural effusion (TPE) from other PPEs based on pleural fluid ADA levels alone. LDH/ADA ratio as an indicator for ruling out tuberculosis was analyzed in few studies with high sensitivity and specificity. The pleural fluid cytology has a varying sensitivity, with a maximum of only 60% and it may increase with subsequent tapping. Closed pleural biopsy using a Cope or Abrams needle has a sensitivity up to 80% in cases of tuberculous effusion and 40%-73% in cases of Malignancies. Semi-rigid thoracoscopy not only allows for visualization of the pleura but also helps in procuring the biopsies under direct visualization from the abnormal looking areas. In cases of primary pleural malignancies like mesothelioma, pleurodesis can also be done in the same setting after taking the biopsy, hence reducing the number of procedures. Limitation of the semi-rigid thoracoscopy is smaller sample size and more superficial sampling of the pleura. Cryobiopsy and Electrocautery guided pleural biopsy using the IT knife are the modifications in the semi-rigid thoracoscopy to overcome the drawback of smaller sample size. While navigation band image guided pleuroscopy helps in better visualization of the vasculature of pleura during the biopsy. Management of pleural effusions has evolved over a period of time. Starting with a single criterion based on pleural fluid proteins to semi-rigid thoracoscopy. The inexhaustible research in this field suggests the desperate need for a gold standard procedure with cost effectiveness in the management of undiagnosed pleural effusions. Semi-rigid thoracoscopy has revolutionized the management of undiagnosed pleural effusions, but it has its own limitations. Various modifications have been proposed and tried to overcome the limitations to make it a cost-effective procedure.
Topics: Biopsy; Humans; Pleura; Pleural Effusion; Thoracoscopes; Thoracoscopy
PubMed: 35074144
DOI: 10.1016/j.ijtb.2021.03.002 -
The Annals of Thoracic Surgery Aug 2021Melanomas represent 3% of all skin cancers but 65% of skin cancer deaths. Metastatic melanoma constitutes about 5% of all secondary malignancies of the lung, yet only 2%...
Melanomas represent 3% of all skin cancers but 65% of skin cancer deaths. Metastatic melanoma constitutes about 5% of all secondary malignancies of the lung, yet only 2% of patients with thoracic metastases have pleural effusions. We report the case of an 80-year-old patient with right-sided pleural effusion and a history of cutaneous melanoma over the left leg. Thoracoscopy revealed numerous clusters of pink and black masses arising from the visceral and parietal pleura along with the diaphragmatic surface. Biopsies confirmed the diagnosis of metastatic cutaneous melanoma.
Topics: Aged, 80 and over; Biopsy; Humans; Male; Melanoma; Pleura; Pleural Neoplasms; Skin Neoplasms; Thoracoscopy; Tomography, X-Ray Computed; Melanoma, Cutaneous Malignant
PubMed: 33421399
DOI: 10.1016/j.athoracsur.2020.09.088 -
Respiratory Medicine 2023Amyloidosis is caused by abnormal protein deposition in various tissues, including the lungs. Pulmonary manifestations of amyloidosis may be categorized by areas of... (Review)
Review
Amyloidosis is caused by abnormal protein deposition in various tissues, including the lungs. Pulmonary manifestations of amyloidosis may be categorized by areas of involvement, such as parenchymal, large airway and pleural involvement. We describe four distinct manifestations of amyloidosis involving the lung and review their clinical, radiological and pathological features and summarize the evidence for treatment in each of these presentations. We describe alveolar-septal amyloidosis, cystic amyloid lung disease, endobronchial amyloidosis and pleural amyloidosis.
Topics: Humans; Lung; Amyloidosis; Lung Diseases; Amyloid; Pleura
PubMed: 37839615
DOI: 10.1016/j.rmed.2023.107426 -
Ultraschall in Der Medizin (Stuttgart,... Apr 2024The CME review presented here is intended to explain the significance of pleural sonography to the interested reader and to provide information on its application. At...
The CME review presented here is intended to explain the significance of pleural sonography to the interested reader and to provide information on its application. At the beginning of sonography in the 80 s of the 20th centuries, with the possible resolution of the devices at that time, the pleura could only be perceived as a white line. Due to the high impedance differences, the pleura can be delineated particularly well. With the increasing high-resolution devices of more than 10 MHz, even a normal pleura with a thickness of 0.2 mm can be assessed. This article explains the special features of the examination technique with knowledge of the pre-test probability and describes the indications for pleural sonography. Pleural sonography has a high value in emergency and intensive care medicine, preclinical, outpatient and inpatient, in the general practitioner as well as in the specialist practice of pneumologists. The special features in childhood (pediatrics) as well as in geriatrics are presented. The recognition of a pneumothorax even in difficult situations as well as the assessment of pleural effusion are explained. With the high-resolution technology, both the pleura itself and small subpleural consolidations can be assessed and used diagnostically. Both the direct and indirect sonographic signs and accompanying symptoms are described, and the concrete clinical significance of sonography is presented. The significance and criteria of conventional brightness-encoded B-scan, colour Doppler sonography (CDS) with or without spectral analysis of the Doppler signal (SDS) and contrast medium ultrasound (CEUS) are outlined. Elastography and ultrasound-guided interventions are also mentioned. A related further paper deals with the diseases of the lung parenchyma and another paper with the diseases of the thoracic wall, diaphragm and mediastinum.
Topics: Humans; Child; Pleura; Pleural Effusion; Lung; Lung Diseases; Thorax; Ultrasonography
PubMed: 38237634
DOI: 10.1055/a-2189-5050 -
Seminars in Ultrasound, CT, and MR Feb 2024Thoracic Ultrasonography involves the ultrasonographic examination of the lungs, pleura, and diaphragm. This provides a plethora of clinical information during the point... (Review)
Review
Thoracic Ultrasonography involves the ultrasonographic examination of the lungs, pleura, and diaphragm. This provides a plethora of clinical information during the point of care assessment of patients. The air filled lungs create consistent artifacts and careful examination and understanding of these artefactual signs can provide useful information on underlying clinicopathologic states. This review aims to provide a review of the ultrasound signs and features that can be seen in horacic ultrasonography and summarize the clinical evidence to support its use.
Topics: Humans; Pleura; Diaphragm; Point-of-Care Systems; Lung; Ultrasonography
PubMed: 38244897
DOI: 10.1053/j.sult.2024.01.001 -
Neurosurgery Clinics of North America Jan 2020The lateral retropleural thoracic approach offers minimally invasive access for the treatment of thoracic spine pathology, specifically thoracic herniated discs.... (Review)
Review
The lateral retropleural thoracic approach offers minimally invasive access for the treatment of thoracic spine pathology, specifically thoracic herniated discs. Alternatives to the retropleural approach traditionally included posterolateral or anterior approaches, which carry increased morbidity. The retropleural approach affords lateral access to the thoracic spine that allows for addressing pathology such as herniated discs, corpectomy, tumor, or trauma. This article outlines preoperative workup and planning, intraoperative steps, tips, and postoperative care.
Topics: Humans; Minimally Invasive Surgical Procedures; Neurosurgical Procedures; Pleura; Spine; Thoracic Surgical Procedures; Thoracic Vertebrae; Treatment Outcome
PubMed: 31739928
DOI: 10.1016/j.nec.2019.08.005 -
American Journal of Respiratory and... Jan 2024
Topics: Humans; Cryoglobulins; Pleura
PubMed: 37824743
DOI: 10.1164/rccm.202301-0082IM -
Clinical Imaging Nov 2021Extrapleural space (EPS) is a potential space between the outer layer of the parietal pleura and the inner layer of the chest wall and the diaphragm. Many different... (Review)
Review
Extrapleural space (EPS) is a potential space between the outer layer of the parietal pleura and the inner layer of the chest wall and the diaphragm. Many different pathologies including chronic inflammatory conditions, infections, trauma, neoplastic disease (both benign and malignant) as well as many infiltrative disorders can involve the EPS. It is one of the frequently overlooked entity on imaging due to relative lack of understanding of the anatomy and the imaging appearances of the diseases localized to this space. The knowledge of the EPS is essential for the radiologists as the pathologies which involve the EPS may require different treatment approach compared to pleural or parenchymal lung disease. Additionally, the EPS involvement may influence the staging and treatment planning for chest malignancies. In this review, we give an overview of the anatomy and various pathologies involving EPS, utility of different imaging modalities in the evaluation of EPS lesions with emphasis on cross sectional imaging and emerging technologies like spectral CT and its role in recognizing the imaging features which enable specific diagnosis of various pathologies.
Topics: Diaphragm; Humans; Multimodal Imaging; Pleura; Pleural Neoplasms; Thoracic Neoplasms; Tomography, X-Ray Computed
PubMed: 33892397
DOI: 10.1016/j.clinimag.2021.03.038