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PloS One 2022Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but...
BACKGROUND
Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis.
METHODS
In total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively.
RESULTS
The cohort median age was 41 (range 22-53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6-1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively.
CONCLUSIONS
Visceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence.
Topics: Adult; Chest Pain; Endometriosis; Female; Humans; Middle Aged; Pleura; Pleural Cavity; Pneumothorax; Retrospective Studies; Thoracic Surgery, Video-Assisted; Young Adult
PubMed: 35544515
DOI: 10.1371/journal.pone.0268299 -
Chest Dec 2021The "buffalo chest" is a condition in which a simultaneous bilateral pneumothorax occurs due to a communication of both pleural cavities caused by an iatrogenic or...
BACKGROUND
The "buffalo chest" is a condition in which a simultaneous bilateral pneumothorax occurs due to a communication of both pleural cavities caused by an iatrogenic or idiopathic fenestration of the mediastinum. This rare condition is known by many clinicians because of a particular anecdote which stated that Native Americans could kill a North American bison with a single arrow in the chest by creating a simultaneous bilateral pneumothorax, due to the animal's peculiar anatomy in which there is one contiguous pleural space due to an incomplete mediastinum.
RESEARCH QUESTION
What evidence is there for the existence of buffalo chest?
STUDY DESIGN AND METHODS
The term "buffalo chest" and its anecdote were first mentioned in a ''personal communication'' by a veterinarian in the Annals of Surgery in 1984. A mixed method research was performed on buffalo chest and its etiology. A total of 47 cases of buffalo chest were identified in humans.
RESULTS
This study found that all authors were referring to the article from 1984 or to each other. Evidence was found for interpleural communications in other mammal species, but no literature on the anatomy of the mediastinum of the bison was found. The main reason for this research was fact-checking the origin of the anecdote and search for evidence for the existence of buffalo chest. Autopsies were performed on eight bison, and four indeed were found to have had interpleural communications.
INTERPRETATION
We hypothesize that humans can also have interpleural fenestrations, which can be diagnosed when a pneumothorax occurs.
Topics: Anatomic Variation; Animals; Bison; Humans; Mediastinum; Pleural Cavity; Pneumothorax; Thoracotomy
PubMed: 34216606
DOI: 10.1016/j.chest.2021.06.043 -
Prilozi (Makedonska Akademija Na... Sep 2017The authors present a rare case of giant mediastinal cyst which arises from the thymus gland, and goes down in both pleural spaces, especially in the right chest cavity...
The authors present a rare case of giant mediastinal cyst which arises from the thymus gland, and goes down in both pleural spaces, especially in the right chest cavity where a dominant part of the cyst was present. The cyst was full with 2.5 liters of transparent fluid, and compressed surrounding structures - heart and both lungs, especially the right one which was partially collapsed. The patient was a 52 years old woman, without any clinical symptoms. Accidentally, on the screened chest X-ray a shading in the distal third of the right chest was detected. The case was well documented with a CT of the chest, and an indication for surgical treatment was made. The surgery was done successfully in general anesthesia according to the small right anterior thoracotomy from which a giant part of the cyst was mobilized, which was in the right pleural cavity, but, also, the thymus with the origin of the cyst in the anterior and superior mediastinum was completely removed. In the end, a part of the cyst which was in the left pleural cavity was removed.
Topics: Biopsy; Female; Humans; Incidental Findings; Mediastinal Cyst; Middle Aged; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28991774
DOI: 10.1515/prilozi-2017-0032 -
La Tunisie Medicale 2022Lung ultrasound (LUS) has been recommended by the British Thoracic Society as a standard of care before performing pleural procedures since 2010. Indeed, the choice of... (Comparative Study)
Comparative Study
INTRODUCTION
Lung ultrasound (LUS) has been recommended by the British Thoracic Society as a standard of care before performing pleural procedures since 2010. Indeed, the choice of the puncture site based only on physical examination and chest x-ray can lead to complications. The aim of this study was to compare the accuracy of pleural puncture sites using LUS as opposed to clinical examination.
METHODS
An evaluative prospective study including 43 patients hospitalized in the pneumology department at the Military Hospital of Tunis was conducted between January and November 2021.Pleural puncture sites were proposed by two groups involving 'senior' and 'junior' physicians, classified according to their experience and grades, based on the clinical examination and the chest x-ray findings. The accuracy of the proposed sites was then verified by an ultrasound-qualified "expert" using LUS.
RESULTS
The mean age was 60 ± 17 years. LUS revealed the presence of pleural effusion in 88% of the cases (n=38). Differential diagnosis was therefore excluded in 12% of the cases (n=5), including pleural thickening (5%, n=2) and atelectasis (7%, n=3). Compared to LUS, clinical examination and chest x-ray had lower sensitivities, estimated at 74% and 83%, respectively. The clinical identification error rate was significantly higher in junior (77%) compared to senior physicians (49%) (p<0.05). LUS prevented possible accidental organ puncture in 36% of the cases (n=31). The risk factors associated with inaccurate clinical site selection included right-sided effusion and minimal pleural effusion on chest radiography, with an estimated relative risk (RR) of 1.44 [CI95%:0.56-3.72] and 1.82 [CI95%:0.52-6.40], respectively. The experience of the senior physicians influenced the choice of the clinical sites with moderate agreement (Kappa index: 0.4-0.6).
CONCLUSION
Compared to the ACPA- group, the ACPA+ one had more lung-hyperinflation and OVI, and comparative percentages of RVI, MVI, and NSVI.
CONCLUSION
LUS significantly improves the accuracy of pleural puncture sites, thus minimizing the risk of complications regardless of the operator's level of clinical experience.
Topics: Adult; Aged; Humans; Middle Aged; Lung; Pleural Effusion; Prospective Studies; Punctures; Radiography, Thoracic; Ultrasonography; Pleural Cavity
PubMed: 36571732
DOI: No ID Found -
Proceedings of SPIE--the International... 2022PDT dose is the product of the photosensitizer concentration and the light fluence in the target tissue. For improved dosimetry during plural photodynamic therapy (PDT),...
PDT dose is the product of the photosensitizer concentration and the light fluence in the target tissue. For improved dosimetry during plural photodynamic therapy (PDT), an eight-channel PDT dose dosimeter was developed to measure both the light fluence and the photosensitizer concentration simultaneously from eight different sites in the pleural cavity during PDT. An isotropic detector with bifurcated fibers was used for each channel to ensure detected light was split equally to the photodiode and spectrometer. The light fluence rate distribution is monitored using an IR navigation system. The navigation system allows 2D light fluence mapping throughout the whole pleural cavity rather than just the selected points. The fluorescence signal is normalized by the light fluence measured at treatment wavelength. We have shown that the absolute photosensitizer concentration can be obtained by applying optical properties correction and linear spectral fitting to the measured fluorescence data. The detection limit and the optical property correction factor of each channel were determined and validated using tissue-simulating phantoms with known varying concentration of Photofrin. Tissue optical properties are determined using an absorption spectroscopy probe immediately before PDT at the same sites. The combination of 8-channel PDT dosimeter system and IR navigation system, which can calculate light fluence rate in the pleural cavity in real-time, providing a mean to determine the distribution of PDT dose on the entire pleural cavity to investigate the heterogeneity of PDT dose on the pleural cavity.
PubMed: 35573026
DOI: 10.1117/12.2612188 -
Nature Communications May 2021During injury, monocytes are recruited from the circulation to inflamed tissues and differentiate locally into mature macrophages, with prior reports showing that cavity...
During injury, monocytes are recruited from the circulation to inflamed tissues and differentiate locally into mature macrophages, with prior reports showing that cavity macrophages of the peritoneum and pericardium invade deeply into the respective organs to promote repair. Here we report a dual recombinase-mediated genetic system designed to trace cavity macrophages in vivo by intersectional detection of two characteristic markers. Lineage tracing with this method shows accumulation of cavity macrophages during lung and liver injury on the surface of visceral organs without penetration into the parenchyma. Additional data suggest that these peritoneal or pleural cavity macrophages do not contribute to tissue repair and regeneration. Our in vivo genetic targeting approach thus provides a reliable method to identify and characterize cavity macrophages during their development and in tissue repair and regeneration, and distinguishes these cells from other lineages.
Topics: Animals; Cell Lineage; Cells, Cultured; Liver; Lung Injury; Macrophage Activation; Macrophages; Mice, Inbred C57BL; Mice, Knockout; Mice, Transgenic; Microscopy, Fluorescence; Monocytes; Peritoneal Cavity; Phagocytosis; Pleural Cavity; Mice
PubMed: 34001904
DOI: 10.1038/s41467-021-23197-7 -
BMC Pulmonary Medicine Sep 2022Pleural infection is an infection of the pleural space that is usually treated with antibiotics and source control. Chest tube insertion is the most popular and widely... (Observational Study)
Observational Study
BACKGROUND
Pleural infection is an infection of the pleural space that is usually treated with antibiotics and source control. Chest tube insertion is the most popular and widely used drainage technique. We typically attempt to place the tube at the bottom of the thoracic cavity to consider the effects of gravity; however, the effectiveness of this practice is not well-defined. Therefore, we aimed to examine whether the position of the tip of the thoracic tube affects treatment failure in patients with pleural infection.
METHODS
In this retrospective observational study, patients with pleural infection who underwent thoracic tube insertion were divided into two groups: those with the tip of the tube positioned below the 10th thoracic vertebra at the level of the diaphragm (lower position group) and those with the tip placed above the 9th thoracic vertebra (upper position group). We compared whether the position of the tube tip affected treatment failure. Stabilized inverse probability treatment weights (SIPTW) were used to balance the baseline characteristics between the groups. Treatment failure showed a composite outcome of hospital death, referral to surgeons for surgery, and additional chest tube insertion.
RESULTS
Among the 87 patients, 41 and 46 patients were in the lower and upper groups, respectively. No significant difference was observed in the composite outcomes between the groups (46.3% vs. 54.3%, P = 0.596). There was also no significant difference in the composite outcome between both groups after adjusting for SIPTW (52.3% vs. 68.8%, P = 0.286).
CONCLUSIONS
There were no significant differences in the treatment failure in this study addressing pleural infection treatment, in which the drain tip position was stratified by the 9th and 10th thoracic vertebrae. The position of the tip of the thoracic tube may not be important for pleural infection treatment providing that it is in the thoracic cavity. Trial registration The participants were registered retrospectively.
Topics: Chest Tubes; Humans; Pleural Cavity; Pleural Diseases; Retrospective Studies; Treatment Failure
PubMed: 36127681
DOI: 10.1186/s12890-022-02157-x -
Reports of Practical Oncology and... 2017Malignant pleural mesothelioma (MPM) is a rare and aggressive disease that poses a treatment challenge in spite of recent technical developments. The aim of this...
BACKGROUND
Malignant pleural mesothelioma (MPM) is a rare and aggressive disease that poses a treatment challenge in spite of recent technical developments. The aim of this retrospective analysis is to assess the feasibility of administering intensity-modulated radiotherapy (IMRT) to the pleural cavity using helical tomotherapy in patients who had undergone pleurectomy/decortication (P/D) and also the resulting toxicity levels.
PATIENTS AND METHODS
Ten patients who had MPM and had undergone P/D were treated with pleural cavity irradiation that included a median dose of 52.2 Gy using helical tomotherapy. The median age of the patients was 53 years (31-74). In addition to clinical and diagnostic findings from regular follow-up examinations, we evaluated the dose distribution for other organs at risk to assess treatment in relation to toxicity, with special regard for the underlying intact lung.
RESULTS
The mean lung dose on the treatment site was 32.8 Gy (±6.8). The V was 71.7% (±17.2). No treatment-related toxicity that exceeded grade III according to common toxicity criteria (CTC) was observed. Median progression-free survival (PFS) was 13 months with a median overall survival (OAS) of 19 months.
CONCLUSION
The findings of this analysis provide data indicating that sparing the underlying lung in patients with MPM after P/D is not only feasible with helical tomotherapy, but that this treatment also causes reasonably few side effects.
PubMed: 28831280
DOI: 10.1016/j.rpor.2017.07.006 -
PloS One 2016Pleural tuberculosis (TB), a form of extrapulmonary TB, can be difficult to diagnose. High numbers of lymphocytes in pleural fluid have been considered part of the... (Comparative Study)
Comparative Study
Pleural tuberculosis (TB), a form of extrapulmonary TB, can be difficult to diagnose. High numbers of lymphocytes in pleural fluid have been considered part of the diagnostic criteria for pleural TB; however, in many cases, neutrophils rather than lymphocytes are the predominant cell type in pleural effusions, making diagnosis more complicated. Additionally, there is limited information on the clinical and laboratory characteristics of neutrophil-predominant pleural effusions caused by Mycobacterium tuberculosis (MTB). To investigate clinical and laboratory differences between lymphocyte- and neutrophil-predominant pleural TB, we retrospectively analyzed 200 patients with the two types of pleural TB. Of these patients, 9.5% had neutrophil-predominant pleural TB. Patients with lymphocyte-predominant and neutrophil-predominant pleural TB showed similar clinical signs and symptoms. However, neutrophil-predominant pleural TB was associated with significantly higher inflammatory serum markers, such as white blood cell count (P = 0.001) and C-reactive protein (P = 0.001). Moreover, MTB was more frequently detected in the pleural fluid from patients in the neutrophil-predominant group than the lymphocyte-predominant group, with the former group exhibiting significantly higher rates of positive results for acid-fast bacilli in sputum (36.8 versus 9.4%, P = 0.003), diagnostic yield of MTB culture (78.9% versus 22.7%, P < 0.001) and MTB detected by polymerase chain reaction (31.6% versus 5.0%, P = 0.001). Four of seven patients with repeated pleural fluid analyses revealed persistent neutrophil-predominant features, which does not support the traditional viewpoint that neutrophil-predominant pleural TB is a temporary form that rapidly develops into lymphocyte-predominant pleural TB. In conclusion, neutrophil-predominant pleural TB showed a more intense inflammatory response and a higher positive rate in microbiological testing compared to lymphocyte-predominant pleural TB. Pleural TB should be considered in neutrophil-predominant pleural effusions, and microbiological tests are warranted.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Laboratories; Lymphocytes; Male; Middle Aged; Neutrophils; Pleural Cavity; Sputum; Tuberculosis, Pleural
PubMed: 27788218
DOI: 10.1371/journal.pone.0165428 -
Monaldi Archives For Chest Disease =... Sep 2023Chylothorax indicates the accumulation of chyle in the pleural cavity. It is a rare cause of pleural effusion, especially bilaterally. In clinical practice, the presence...
Chylothorax indicates the accumulation of chyle in the pleural cavity. It is a rare cause of pleural effusion, especially bilaterally. In clinical practice, the presence of milky fluid in the pleural cavity raises the suspicion of chylothorax. The most common cause is trauma, iatrogenic or non, owing to thoracic duct injury, which transports chyle from the lymphatic system into the bloodstream. The case we describe is of a 53-year-old female who was referred to our hospital with bilateral pleural effusions and a left supraclavicular mass. From the diagnostic studies, the nontraumatic causes of chylothorax were excluded. The potential diagnosis was traumatic chylothorax, a diagnosis of exclusion, as it appeared after muscle stretch and receded with a fat-free diet and repose without any relapse.
PubMed: 37768210
DOI: 10.4081/monaldi.2023.2684