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Respiratory Investigation Jul 2024Thoracoscopy is useful for diagnosing unexplained pleural effusions. A sufficient specimen volume is often difficult to obtain using forceps biopsies (FBs) but can be... (Observational Study)
Observational Study
BACKGROUND
Thoracoscopy is useful for diagnosing unexplained pleural effusions. A sufficient specimen volume is often difficult to obtain using forceps biopsies (FBs) but can be obtained with pleural cryobiopsies (CBs). This study aimed to assess the utility and safety of CB during thoracoscopy in the Japanese population.
METHODS
Patients who underwent thoracoscopic CBs at the Japanese Red Cross Medical Center between January 2017 and August 2023 were included in the study. Data were retrospectively analyzed, including clinical data, thoracoscopic findings, specimen size, diagnostic yield, and complications. The number of collected specimens and the freezing time were left to the discretion of the attending physician.
RESULTS
Twenty-six patients underwent thoracoscopic CB. Specimens obtained by CB were larger than those obtained by FB. Primary lung cancer was the most common cause of pleural effusion, followed by malignant pleural mesothelioma. CB contributed to the diagnosis in 24 of 26 cases (92.3%) and FB contributed to the diagnosis in 11 of 18 cases (61.1%). Severe fibrosis could be diagnosed in all 3 cases by CB, but not by FB. The common complications of CB included bleeding at the biopsy site and atelectasis, but no severe complications occurred.
CONCLUSIONS
The utility and safety of thoracoscopic CB for diagnosing pleural effusions in Japan were verified. The diagnostic yield, specimen size, and safety profile of CB support the diagnostic utility of this method.
Topics: Humans; Retrospective Studies; Thoracoscopy; Male; Female; Aged; Biopsy; Japan; Middle Aged; Lung Neoplasms; Pleural Effusion; Aged, 80 and over; Pleural Neoplasms; Mesothelioma, Malignant; Adult
PubMed: 38718435
DOI: 10.1016/j.resinv.2024.05.001 -
Cureus Apr 2024Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease...
Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease (ADPKD). The patient had undergone right PCNL in 2021 and 2023 and presented to the emergency department with symptoms of fever, breathlessness, and cough lasting one week. Imaging studies, including chest radiograph and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, revealed gross right pleural effusion, right perinephric abscess, multiple renal cysts, right renal calculi and right ureteric calculi causing severe right hydronephrosis and proximal hydroureter. The imaging also confirmed a nephropleural fistula, with the right kidney's perinephric abscess communicating with the right pleura via the right subhepatic space. Subsequent thoracic ultrasound showed a large effusion of 1500ml with underlying lung collapse. Diagnostic thoracocentesis confirmed empyema, necessitating immediate tube thoracostomy. CT intravenous urography confirmed a non-functioning right kidney. The perinephric abscess was drained with a PCNL tube and meanwhile, pleural fluid and perinephric abscess isolated Klebsiella pneumonia on cultures. The patient received parenteral antibiotics and intravenous fluids and had an intercostal drain and PCNL tube in place for drainage. A right nephrectomy was recommended due to the non-functioning right kidney and the patient is awaiting the procedure.
PubMed: 38707149
DOI: 10.7759/cureus.57671 -
Clinical Rheumatology Jun 2024To explore the diagnostic value of lung ultrasound (LUS) and pleural shear wave elastography (SWE) for connective tissue disease-interstitial lung disease (CTD-ILD).
OBJECTIVE
To explore the diagnostic value of lung ultrasound (LUS) and pleural shear wave elastography (SWE) for connective tissue disease-interstitial lung disease (CTD-ILD).
METHODS
We selected 104 patients diagnosed with connective tissue disease (CTD) at our hospital. All patients underwent LUS, SWE, and high-resolution computed tomography (HRCT). With HRCT as the imaging gold standard for diagnosis, patients were categorized into CTD-ILD and CTD-non-ILD groups. We employed paired chi-square tests to compare the diagnostic differences between HRCT and LUS for ILD. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of pleural SWE for ILD. Correlation analysis was performed between pleural elasticity values and lung ultrasound scores.
RESULTS
The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of LUS for diagnosing CTD-ILD were 93.3%, 86.2%, 6.761, and 0.078, respectively. There was no statistically significant difference in the results between HRCT and LUS (P = 1.000), with a kappa value of 0.720 (P < 0.001). There was a statistically significant difference in the pleural elasticity in the bilateral lower back region between the case and control groups (P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for pleural SWE in diagnosing CTD-ILD was 0.685. In CTD-ILD patients, there was no significant correlation between pleural elasticity values and LUS scores (P > 0.05).
CONCLUSION
The LUS can serve as an important imaging method for screening for CTD-ILD and assessing the severity of the disease. However, pleural SWE has been shown to demonstrate lower diagnostic efficacy for CTD-ILD, and its ability to assess disease severity is limited.
Topics: Humans; Lung Diseases, Interstitial; Elasticity Imaging Techniques; Female; Male; Middle Aged; Connective Tissue Diseases; Lung; Adult; Aged; ROC Curve; Tomography, X-Ray Computed; Pleura; Ultrasonography; Sensitivity and Specificity
PubMed: 38700662
DOI: 10.1007/s10067-024-06983-8 -
Archivos de Bronconeumologia Jul 2024
Topics: Humans; Pneumopericardium; Pacemaker, Artificial; Heart Atria; Heart Injuries; Pericardium; Pleura; Male; Aged; Female; Time Factors; Electrodes, Implanted
PubMed: 38697901
DOI: 10.1016/j.arbres.2024.03.027 -
European Journal of Cardio-thoracic... May 2024Extended pleurectomy-decortication is a cytoreductive surgical treatment for malignant pleural mesothelioma. Prolonged air leak remains a major postoperative challenge,...
Extended pleurectomy-decortication is a cytoreductive surgical treatment for malignant pleural mesothelioma. Prolonged air leak remains a major postoperative challenge, lengthening hospital stay and increasing morbidity. In this video report, we present a stepwise approach for visceral decortication and introduce the concept of aerostasis by construction of an artificial neopleura. Our results suggest that improved aerostasis results in shortened air leak duration.
Topics: Humans; Pleura; Pleural Neoplasms; Mesothelioma; Mesothelioma, Malignant; Postoperative Complications; Lung Neoplasms; Male; Pneumothorax
PubMed: 38696760
DOI: 10.1093/ejcts/ezae181 -
Respirology Case Reports May 2024Calcifying fibrous tumours of the pleura (CFTP) typically appear as calcified, non-enhancing lesions on chest CT scans. However, enhancing pleural lesions can mimic...
Calcifying fibrous tumours of the pleura (CFTP) typically appear as calcified, non-enhancing lesions on chest CT scans. However, enhancing pleural lesions can mimic malignancy like mesothelioma. We report a rare case that enhancing pleural thickening, confirmed as CFTP through pathological examination, despite the absence of visible calcification on radiological imaging.
PubMed: 38694935
DOI: 10.1002/rcr2.1365 -
Surgical Pathology Clinics Jun 2024Spindle cell lesions of the pleura and pericardium are rare. Distinction from sarcomatoid mesothelioma, which has a range of morphologic patterns, can be difficult, but... (Review)
Review
Spindle cell lesions of the pleura and pericardium are rare. Distinction from sarcomatoid mesothelioma, which has a range of morphologic patterns, can be difficult, but accurate diagnosis matters. This article provides practical guidance for the diagnosis of pleural spindle cell neoplasms, focusing on primary lesions.
Topics: Humans; Pericardium; Pleural Neoplasms; Diagnosis, Differential; Heart Neoplasms; Mesothelioma; Sarcoma; Biomarkers, Tumor; Pleura
PubMed: 38692809
DOI: 10.1016/j.path.2024.01.001 -
Bio Systems Jun 2024Cell shapes in tissues are affected by the biophysical interaction between cells. Tissue forces can influence specific cell features such as cell geometry and cell...
Cell shapes in tissues are affected by the biophysical interaction between cells. Tissue forces can influence specific cell features such as cell geometry and cell surface area. Here, we examined the 2-dimensional shape, size, and perimeter of pleural epithelial cells at various lung volumes. We demonstrated a 1.53-fold increase in 2-dimensional cell surface area and a 1.43-fold increase in cell perimeter at total lung capacity compared to residual lung volume. Consistent with previous results, close inspection of the pleura demonstrated wavy folds between pleural epithelial cells at all lung volumes. To investigate a potential explanation for the wavy folds, we developed a physical simulacrum suggested by D'Arcy Thompson in On Growth and Form. The simulacrum suggested that the wavy folds were the result of redundant cell membranes unable to contract. To test this hypothesis, we developed a numerical simulation to evaluate the impact of an increase in 2-dimensional cell surface area and cell perimeter on the shape of the cell-cell interface. Our simulation demonstrated that an increase in cell perimeter, rather than an increase in 2-dimensional cell surface area, had the most direct impact on the presence of wavy folds. We conclude that wavy folds between pleural epithelial cells reflects buckling forces arising from the excess cell perimeter necessary to accommodate visceral organ expansion.
Topics: Epithelial Cells; Pleura; Animals; Cell Shape; Humans; Lung; Models, Biological; Computer Simulation; Biomechanical Phenomena
PubMed: 38692427
DOI: 10.1016/j.biosystems.2024.105216