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Seminars in Nuclear Medicine Nov 2022Diseases of pleura are not only common but also have a significant impact on patients' outcomes. While early detection and treatment are imperative in reducing this... (Review)
Review
Diseases of pleura are not only common but also have a significant impact on patients' outcomes. While early detection and treatment are imperative in reducing this burden, many pleural entities present similarly, thus posing a diagnostic dilemma for radiologists requiring critical further workup. While chest radiography, CT, and image-guided thoracentesis are primarily utilized as the initial imaging techniques for the workup of pleural diseases, MRI, and FDG-PET/CT are also frequently employed to investigate the root cause of pleural abnormalities. By elucidating the common imaging features of neoplastic, inflammatory, and infectious pleural pathologies, clinicians can quickly and easily differentiate the various pleural diseases, rapidly reach the correct diagnosis, and ultimately improve patient outcomes.
Topics: Humans; Pleura; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed; Pleural Diseases
PubMed: 35738911
DOI: 10.1053/j.semnuclmed.2022.04.009 -
RoFo : Fortschritte Auf Dem Gebiete Der... Apr 2021
Topics: Adult; Female; Humans; Lung; Paresthesia; Pleura; Solitary Fibrous Tumors; Thorax; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33302313
DOI: 10.1055/a-1224-4279 -
Clinical Imaging May 2021Pulmonary sequestration consists of a nonfunctioning mass of lung tissue, either sharing the pleural envelope of the normal lung (intralobar) or with its own pleura... (Review)
Review
Pulmonary sequestration consists of a nonfunctioning mass of lung tissue, either sharing the pleural envelope of the normal lung (intralobar) or with its own pleura (extralobar), lacking normal communication with the tracheobronchial tree and receiving its arterial supply by one or more systemic vessels. It is the second most common congenital lung anomaly according to pediatric case series, but its real prevalence is likely to be underestimated, and imaging plays a key role in the diagnosis and treatment management of the condition and its potential complications. We will give a brief overview of the pathophysiology, clinical presentation and imaging findings of intra- and extralobar pulmonary sequestration, with particular reference to multidetector computed tomography as part of a powerful and streamlined diagnostic approach.
Topics: Bronchi; Bronchopulmonary Sequestration; Child; Humans; Lung; Pleura; Radiologists
PubMed: 33310586
DOI: 10.1016/j.clinimag.2020.11.040 -
Respiratory Medicine Jul 2023Pleuroscopy, also known as medical thoracoscopy or local anesthesia thoracoscopy, is a commonly utilized procedure in the growing field of interventional pulmonology and... (Review)
Review
Pleuroscopy, also known as medical thoracoscopy or local anesthesia thoracoscopy, is a commonly utilized procedure in the growing field of interventional pulmonology and considered a required procedure as part of the interventional pulmonology fellowship curriculum. Pleuroscopy is mainly utilized for parietal pleural biopsies in patients with undiagnosed pleural effusions, with a comparable diagnostic yield to video-assisted thoracoscopy (VATS) (>92%). Pleuroscopy is also performed for talc insufflation for pleurodesis, indwelling pleural catheter insertion, and rarely for decortication in patients with stage 2 empyema. Though these procedures can be done under local anesthesia with moderate sedation, an increasing number of cases are being performed with the presence of the anesthesiologist providing monitored anesthesia care (MAC). Given that a significant number of patients undergoing pleuroscopy will have significant co-morbidities, proceduralists and anesthesiologists must be prepared to manage these cases in a non-OR setup. In this article, we discuss some of the technical aspects of pleuroscopy, and highlight the peri-operative considerations for proceduralists and anesthesiologists in managing these patients including the role of ultrashort sedatives and intraoperative procedural and anesthetic considerations. We also discuss the upcoming adjunctive role of local and regional anesthesia techniques in management of these patients. In addition, we summarize the current data regarding various regional anesthesia techniques and discuss avenues for further research.
Topics: Humans; Thoracoscopy; Pleural Effusion; Pleura; Anesthetics; Hypnotics and Sedatives
PubMed: 37028564
DOI: 10.1016/j.rmed.2023.107225 -
General Thoracic and Cardiovascular... Sep 2021Pleurectomy/decortication has been preferably employed as a curative-intent surgery for malignant pleural mesothelioma. However, visceral pleurectomy during...
OBJECTIVE
Pleurectomy/decortication has been preferably employed as a curative-intent surgery for malignant pleural mesothelioma. However, visceral pleurectomy during pleurectomy/decortication provides technical challenges. For visceral pleurectomy, pleural incisions are commonly made to create a dissection plane between the visceral pleura and the lung parenchyma, which may cause tumor dissemination and may not allow en bloc complete resection of the entire pleura. To overcome such potential disadvantages, we have developed a novel surgical technique without any pleural incision (non-incisional pleurectomy/decortication) to achieve en bloc removal of the entire pleura.
METHODS
A total of 36 consecutive patients who underwent non-incisional pleurectomy/decortication for malignant pleural mesothelioma from January 2017 through December 2020 in our institute were retrospectively reviewed to assess the feasibility.
RESULTS
Macroscopic complete resection was achieved in 31 patients (86.1%) with non-incisional pleurectomy/decortication. In the majority of patients (n = 29), en bloc complete resection of the entire pleura was achieved (without pleural laceration in 10 and with some pleural laceration in 19 patients). The total operation time and the duration of visceral pleurectomy were significantly shorter as compared with those for conventional pleurectomy/decortication (median, 350 versus 506 min [P = 0.011], and 43 versus 97 min [P < 0.001], respectively). Among 36 patients who underwent non-incisional pleurectomy/decortication, postoperative complications developed in 13 patients (36.1%), and one patient died on the postoperative day 95 caused by aggressive tumor progression of residual tumor.
CONCLUSIONS
Non-incisional pleurectomy/decortication is a fast and feasible technique to achieve en bloc macroscopic complete resection for malignant pleural mesothelioma.
Topics: Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleura; Pleural Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 34028663
DOI: 10.1007/s11748-021-01643-z -
Histopathology Jan 2024Primary mesenchymal tumours of the pleura are uncommon and can be diagnostically challenging due to their overlapping histopathologic and immunophenotypic features.... (Review)
Review
Primary mesenchymal tumours of the pleura are uncommon and can be diagnostically challenging due to their overlapping histopathologic and immunophenotypic features. Herein we discuss selected mesenchymal tumours of the pleura, including solitary fibrous tumour, calcifying fibrous tumour, desmoid fibromatosis, synovial sarcoma, schwannoma, malignant peripheral nerve sheath tumour, inflammatory myofibroblastic tumour, follicular dendritic cell sarcoma, epithelioid hemangioendothelioma, and desmoplastic small round cell tumour. We review their clinicopathologic characteristics, along with an update on the relevant immunohistochemical and molecular features.
Topics: Humans; Pleura; Immunohistochemistry; Neurilemmoma; Solitary Fibrous Tumors; Neurofibrosarcoma
PubMed: 37691389
DOI: 10.1111/his.15035 -
Clinics in Chest Medicine Dec 2021
Review
Topics: Diagnostic Imaging; Humans; Pleura; Pleural Effusion; Ultrasonography
PubMed: 34774166
DOI: 10.1016/j.ccm.2021.07.001 -
Respiratory Medicine Aug 2023Light's criteria falsely label a significant number of effusions as exudates. Such exudative effusions with transudative etiologies are referred to as "pseduoexudates".... (Review)
Review
Light's criteria falsely label a significant number of effusions as exudates. Such exudative effusions with transudative etiologies are referred to as "pseduoexudates". In this review, we discuss a practical approach to correctly classify an effusion that may be a pseudoexudate. A PubMed search yielded 1996 manuscripts between 1990 and 2022. Abstracts were screened and 29 relevant studies were included in this review article. Common etiologies for pseudoexudates include diuretic therapy, traumatic pleural taps, and coronary artery bypass grafting. Here, we explore alternative diagnostic criteria. Concordant exudates (CE), defined as effusions where proteins in pleural fluid/serum (PF/SPr) > 0.5 and pleural fluid LDH level of >160 IU/L (>2/3 upper limit of normal) confer higher predictive value to the Light's criteria. Serum-pleural effusion albumin gradient (SPAG) > 1.2 g/dL and serum-pleural effusion protein gradient (SPPG) > 3.1 g/dL together yielded a sensitivity of 100% in heart failure and a sensitivity of 99% in hepatic hydrothorax whe n identifying pseudoexudates (Bielsa et al., 2012) [5]. Pleural fluid N-Terminal Pro Brain Natriuretic Peptide (NTPBNP) offered a specificity and sensitivity of 99% in identifying pseudoexudates when using a cut-off of >1714 pg/mL (Han et al., 2008) [24]. However, its utility remains questionable. Additionally, we also looked at pleural fluid cholesterol and imaging modalities such as ultrasound and CT scan to measure pleural thickness and nodularity. Finally, the diagnostic algorithm we suggest involves using SPAG >1.2 g/dL and SPPG >3.1 g/dL in effusions classified as exudates when there is a strong clinical suspicion for pseudoexudates.
Topics: Humans; Pleural Effusion; Exudates and Transudates; Thoracentesis; Serum Albumin; Pleura
PubMed: 37172787
DOI: 10.1016/j.rmed.2023.107279 -
BMJ Case Reports Jul 2022
Topics: Humans; Pleura; Pulmonary Fibrosis
PubMed: 35790325
DOI: 10.1136/bcr-2022-251483 -
Chest Sep 2023Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection,... (Review)
Review
Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection, or lobar atelectasis from bronchoscopic lung volume reduction or an endobronchial obstruction. This type of pneumothorax and air leak is clinically inconsequential. Failure to appreciate the benign nature of such air leaks may result in unnecessary pleural procedures or prolonged hospital stay. This review suggests that identification of pressure-dependent pneumothorax is clinically important because the air leak that results is not related to a lung injury that requires repair but rather to a physiological consequence of a pressure gradient. A pressure-dependent pneumothorax occurs during pleural drainage in patients with lung-thoracic cavity shape/size mismatch. It is caused by an air leak related to a pressure gradient between the subpleural lung parenchyma and the pleural space. Pressure-dependent pneumothorax and air leak do not need any further pleural interventions.
Topics: Humans; Pneumothorax; Pneumonectomy; Pleural Cavity; Thoracic Surgical Procedures; Pleura
PubMed: 37187435
DOI: 10.1016/j.chest.2023.04.049