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Thoracic Surgery Clinics Feb 2013Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the... (Review)
Review
Pleural effusions are most often secondary to an underlying condition and may be the first sign of the underlying pathologic condition. The balance between the hydrostatic and oncotic forces dictates pleural fluid homeostasis. The parietal pleura has a more significant role in pleural fluid homeostasis. Its vessels are closer to the pleural space compared with its visceral counterpart; it contains lymphatic stomata, absent on visceral pleura, which are responsible for a bulk clearance of fluid. The diagnosis and successful treatment of pleural effusions requires a mixture of imaging techniques and pleural fluid analysis.
Topics: Body Fluids; Exudates and Transudates; Humans; Pleura; Pleural Cavity; Pleural Effusion
PubMed: 23206712
DOI: 10.1016/j.thorsurg.2012.10.008 -
General Thoracic and Cardiovascular... May 2011Lipoma is a common benign tumor of soft tissues in adults. An intrathoracic location, particularly in the parietal pleura, is rare. We report two cases of pleural... (Review)
Review
Lipoma is a common benign tumor of soft tissues in adults. An intrathoracic location, particularly in the parietal pleura, is rare. We report two cases of pleural parietal lipoma with a review of literature. A preoperative diagnosis was established histologically by fine-needle aspiration in the first case and radiologically by computed tomography scan in the second. Both patients underwent surgical excision via thoracotomy and video-assisted thoracic surgery. Pathology examination confirmed the diagnosis of lipoma. The authors emphasize the necessity of surgical resection because of preoperative diagnostic difficulty of discerning lipoma from well-differentiated liposarcoma.
Topics: Adult; Biopsy, Fine-Needle; Diagnosis, Differential; Humans; Lipoma; Liposarcoma; Male; Middle Aged; Pleura; Pleural Neoplasms; Predictive Value of Tests; Thoracic Surgery, Video-Assisted; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 21547634
DOI: 10.1007/s11748-010-0650-7 -
Journal of Thoracic Oncology : Official... Mar 2020
Topics: Humans; Lung Neoplasms; Perivascular Epithelioid Cell Neoplasms; Pleura
PubMed: 31812753
DOI: 10.1016/j.jtho.2019.11.021 -
Particle and Fibre Toxicology Mar 2010The unique hazard posed to the pleural mesothelium by asbestos has engendered concern in potential for a similar risk from high aspect ratio nanoparticles (HARN) such as... (Review)
Review
Asbestos, carbon nanotubes and the pleural mesothelium: a review of the hypothesis regarding the role of long fibre retention in the parietal pleura, inflammation and mesothelioma.
The unique hazard posed to the pleural mesothelium by asbestos has engendered concern in potential for a similar risk from high aspect ratio nanoparticles (HARN) such as carbon nanotubes. In the course of studying the potential impact of HARN on the pleura we have utilised the existing hypothesis regarding the role of the parietal pleura in the response to long fibres. This review seeks to synthesise our new data with multi-walled carbon nanotubes (CNT) with that hypothesis for the behaviour of long fibres in the lung and their retention in the parietal pleura leading to the initiation of inflammation and pleural pathology such as mesothelioma. We describe evidence that a fraction of all deposited particles reach the pleura and that a mechanism of particle clearance from the pleura exits, through stomata in the parietal pleura. We suggest that these stomata are the site of retention of long fibres which cannot negotiate them leading to inflammation and pleural pathology including mesothelioma. We cite thoracoscopic data to support the contention, as would be anticipated from the preceding, that the parietal pleura is the site of origin of pleural mesothelioma. This mechanism, if it finds support, has important implications for future research into the mesothelioma hazard from HARN and also for our current view of the origins of asbestos-initiated pleural mesothelioma and the common use of lung parenchymal asbestos fibre burden as a correlate of this tumour, which actually arises in the parietal pleura.
Topics: Air Pollutants; Animals; Asbestos; Disease Models, Animal; Epithelium; Humans; Mesothelioma; Metabolic Clearance Rate; Mice; Mineral Fibers; Nanotubes, Carbon; Particle Size; Pleura
PubMed: 20307263
DOI: 10.1186/1743-8977-7-5 -
Respiratory Medicine Aug 2022Medical thoracoscopy (MT) is a well-established diagnostic procedure in cases of unexplained exudative pleural effusions. Despite the advantages of MT, challenges remain...
BACKGROUND
Medical thoracoscopy (MT) is a well-established diagnostic procedure in cases of unexplained exudative pleural effusions. Despite the advantages of MT, challenges remain since occasionally malignancies mimic pleural inflammation.
OBJECTIVES
To assess the relationship between the macroscopic appearance of the pleura at MT, the histology of the pleural biopsy and the final diagnosis after follow up.
METHODS
Data was prospectively collected on patients undergoing MT over 8 years, using a standardised electronic thoracoscopy report. We report the sensitivity, specificity, positive and negative predictive values (PPV, NPV) of the macroscopic changes, the sensitivity of computer tomographic (CT) appearances and final outcome.
RESULTS
A total of 228 thoracoscopies and biopsy were performed, 70 reports described benign macroscopic changes; of these 15.7% had malignant histology. When the final outcome was taken into account, the sensitivity of macroscopic appearance at MT was 91.5%, specificity 76.0%, PPV 88.6% and the NPV 81.4%. Nodular changes were more likely to be associated with malignancy (Chi 75.5, p < 0.05). The CT scans performed prior to thoracoscopy had a poor sensitivity for the diagnosis of malignant pleural effusion (50%) and a good specificity in the diagnosis of benign disease (90.5%).
CONCLUSION
A standardised structured report allows reliable evaluation of the macroscopic findings at MT. The PPV of the macroscopic findings for malignancy is relatively high; however, in a significant minority of cases despite benign-looking macroscopic changes the final diagnosis was malignancy. Careful consideration must be given in cases with benign histology to either monitoring or further diagnostic tests based on clinical suspicion.
Topics: Biopsy; Humans; Pleura; Pleural Effusion; Pleural Effusion, Malignant; Thoracoscopy
PubMed: 35633607
DOI: 10.1016/j.rmed.2022.106883 -
Journal of the Mechanical Behavior of... Nov 2017Tension pneumothorax, a major preventable cause of battlefield death, often arises from chest trauma and is treated by needle decompression to release trapped air from...
Tension pneumothorax, a major preventable cause of battlefield death, often arises from chest trauma and is treated by needle decompression to release trapped air from the pleural cavity. Surgical simulation mannequins are often employed to train medical personnel to perform this procedure properly. Accurate reproduction of the mechanical behavior of the parietal pleura, especially in response to needle penetration, is essential to maximize the fidelity of these surgical simulators. To date, however, the design of pleura-simulating material has been largely empirical and based on subjective practitioner feel rather than on the tissue properties, which have remained unknown. In this study, we performed uniaxial extension tests on samples of cadaveric human parietal pleura. We found that the pleura was highly nonlinear and mildly anisotropic, being roughly twice as stiff in the direction parallel to the ribs vs. perpendicular to the ribs (large-strain modulus = 20.44 vs. 11.49MPa). We also did not find significant correlations for most pleural properties with age or BMI, but it must be recognized that the age range (59 ± 9.5 yrs) and BMI range (31 ± 5.3) of the donors in our study was not what one might expect from combatants, and there could be differences for younger, lighter individuals. We found a significantly higher low-strain modulus in the diabetic donors (0.213 vs. 0.100MPa), consistent with the general tendency of tissue to stiffen in diabetes. The nonlinearity and tensile strength should be considered in material design and selection for future surgical simulators.
Topics: Aged; Anisotropy; Biomechanical Phenomena; Cadaver; Humans; Middle Aged; Pleura; Pneumothorax; Ribs; Simulation Training; Tensile Strength
PubMed: 28780253
DOI: 10.1016/j.jmbbm.2017.07.044 -
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 -
Japanese Journal of Radiology May 2015Pleurodesis is frequently performed to prevent recurrence of pneumothorax or recurrent pleural effusion in benign or malignant conditions. In essence, it involves... (Review)
Review
Pleurodesis is frequently performed to prevent recurrence of pneumothorax or recurrent pleural effusion in benign or malignant conditions. In essence, it involves producing an area of adhesion between the parietal and the visceral layers of the pleura. The approach to this procedure can be divided into chemical and mechanical methods. Chemical pleurodesis is performed by introducing various substances such as talc, bleomycin, povidone iodine or other chemicals into the pleural space typically using a pleural catheter. The instilled substances cause inflammation of the parietal and the visceral layers of the pleura and leads to adhesion of the pleural surfaces, preventing further fluid or air accumulation. Mechanical pleurodesis, which is performed with thoracotomy or thoracoscopy, involves mechanical irritation of the pleura or removal of parietal pleura. It is important for the radiologist to develop an understanding of the clinical indications for pleurodesis, methods for the procedure and post-procedure imaging appearance so the radiologist can provide a correct interpretation and avoid misdiagnosis of the radiologic appearance as chronic infection, tumor or other entities with a similar appearance. Thus, the aim of this article is to review the indications, techniques and post-procedural appearances of pleurodesis from an imaging perspective.
Topics: Chronic Disease; Humans; Pleura; Pleural Effusion; Pleurodesis; Pneumothorax; Recurrence; Tomography, X-Ray Computed
PubMed: 25791777
DOI: 10.1007/s11604-015-0412-7 -
Microvascular Research Jul 2023Inflammatory pleuritis often causes pleural effusions, which are drained through lymphatic vessels (lymphatics) in the parietal pleura. The distribution of button- and...
Inflammatory pleuritis often causes pleural effusions, which are drained through lymphatic vessels (lymphatics) in the parietal pleura. The distribution of button- and zipper-like endothelial junctions can identify the subtypes of lymphatics, the initial, pre-collecting, and collecting lymphatics. Vascular endothelial growth factor receptor (VEGFR)-3 and its ligands VEGF-C/D are crucial lymphangiogenic factors. Currently, in the pleura covering the chest walls, the anatomy of the lymphatics and connecting networks of blood vessels are incompletely understood. Moreover, their pathological and functional plasticity under inflammation and the effects of VEGFR inhibition are unclear. This study aimed to learn the above-unanswered questions and immunostained mouse chest walls as whole-mount specimens. Confocal microscopic images and their 3-dimensional reconstruction analyzed the vasculatures. Repeated intra-pleural cavity lipopolysaccharide challenge induced pleuritis, which was also treated with VEGFR inhibition. Levels of vascular-related factors were evaluated by quantitative real-time polymerase chain reaction. We observed the initial lymphatics in the intercostals, collecting lymphatics under the ribs, and pre-collecting lymphatics connecting both. Arteries branched into capillaries and gathered into veins from the cranial to the caudal side. Lymphatics and blood vessels were in different layers with an adjacent distribution of the lymphatic layer to the pleural cavity. Inflammatory pleuritis elevated expression levels of VEGF-C/D and angiopoietin-2, induced lymphangiogenesis and blood vessel remodeling, and disorganized the lymphatic structures and subtypes. The disorganized lymphatics showed large sheet-like structures with many branches and holes inside. Such lymphatics were abundant in zipper-like endothelial junctions with some button-like junctions. The blood vessels were tortuous and had various diameters and complex networks. Stratified layers of lymphatics and blood vessels were disorganized, with impaired drainage function. VEGFR inhibition partially maintained their structures and drainage function. These findings demonstrate anatomy and pathological changes of the vasculatures in the parietal pleura and their potential as a novel therapeutic target.
Topics: Mice; Animals; Pleura; Vascular Endothelial Growth Factor C; Vascular Endothelial Growth Factor A; Lymphatic Vessels; Lymphangiogenesis; Vascular Endothelial Growth Factor Receptor-3; Receptors, Vascular Endothelial Growth Factor; Inflammation; Pleurisy
PubMed: 37230165
DOI: 10.1016/j.mvr.2023.104546 -
Lung 2001The normal structure and function of the pleura are discussed here in addition to how physiological abnormalities and various pathological processes can upset the finely... (Review)
Review
The normal structure and function of the pleura are discussed here in addition to how physiological abnormalities and various pathological processes can upset the finely balanced situation between the visceral and parietal pleural surfaces, leading to effusion formation, and/or adhesions. The various inflammatory and reactive processes that affect the pleura, together with primary and secondary tumor formations are described. Particular emphasis is placed on those conditions of the pleura that are associated with asbestos exposure because this group of diseases will increase over the next few decades due to the large number of workers who have been exposed to asbestos. They will therefore be of increasing importance to the clinician, radiologist, and pathologist in future years.
Topics: Biomarkers, Tumor; Humans; Pleura; Pleural Diseases; Pleural Effusion
PubMed: 12040428
DOI: 10.1007/s004080000075