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Seminars in Roentgenology Apr 1992In summary, there are a wide range of pulmonary manifestations seen in asbestos-exposed individuals from pleural and parenchymal fibrosis to pleural and parenchymal... (Review)
Review
In summary, there are a wide range of pulmonary manifestations seen in asbestos-exposed individuals from pleural and parenchymal fibrosis to pleural and parenchymal malignancy. The chest roentgenogram has assumed an important role in the detection and surveillance of asbestos-related pleural and parenchymal changes.
Topics: Asbestos; Asbestosis; Humans; Lung Diseases; Lung Neoplasms; Mesothelioma; Pleural Diseases; Pleural Neoplasms; Pulmonary Atelectasis; Radiography
PubMed: 1609299
DOI: 10.1016/0037-198x(92)90053-5 -
Acta Bio-medica : Atenei Parmensis Sep 2020Computed Tomography (CT) is considered part of the routine diagnostic workup for pleural malignancy. The definitive diagnosis of pleural malignancy depends upon...
OBJECTIVE
Computed Tomography (CT) is considered part of the routine diagnostic workup for pleural malignancy. The definitive diagnosis of pleural malignancy depends upon histological confirmation by pleural biopsy. The aim of this study is to assess the sensitivity and specificity of CT, in view of the latest imaging technologies, in detecting pleural malignancy compared to definitive histology achieved via thoracoscopy (VATS).
MATERIALS AND METHODS
We included in this retrospective study 90 patients (36 F, 54 M) with suspected pleural malignancy evaluated in our Institution with CT scan who received a definitive diagnosis after VATS biopsy. Unaware of histopathologic diagnoses CT scans were evaluated by a junior and two experts thoracic radiologist. Conclusions were reached by consensus.
RESULTS
We evaluated all CT signs suggestive for malignant pleural diseases: pleural thickening > 10 mm (Se 0,41 , Sp 0,79); nodular thickening (Se 0,86, Sp 0,75); circumferential thickening (Se 0,79, Sp 0,69); irregular pleural thickening (Se 0,77, Sp 0,91); mediastinal involvement (Se 0,88, Sp 0,64); costal involvement (Se 0,89, Sp 0,60); diaphragmatic involvement (Se 0,88, Sp 0,53). Furthermore, the diagnostic performance of additional CT features was evaluated: concomitant costal, mediastinal and diaphragmatic pleura lesions (Se 0,84, Sp 0,69); nodular/irregular thickening with mediastinal pleural involvement (Se 0,83, Sp 0,90); nodular/irregular thickening with diaphragmatic pleural involvement (Se 0,81, Sp 0,90).
CONCLUSIONS
CT confirms its central role in the pleura malignancy. The high sensibility, respect to previous studies, especially in the presence of nodular pleural thickening, may lead to reconsider at least partly the diagnostic pathway of diffuse pleural disease, avoiding the use of VATS in patients not eligible for surgery, in favor of US or CT guided core biopsy.
Topics: Humans; Pleural Diseases; Pleural Neoplasms; Retrospective Studies; Thoracoscopy; Tomography, X-Ray Computed
PubMed: 32921755
DOI: 10.23750/abm.v91i3.7713 -
Respirology (Carlton, Vic.) Feb 2021
Topics: Humans; Lasers; Pleura; Pleural Neoplasms; Thoracoscopy
PubMed: 33251664
DOI: 10.1111/resp.13982 -
European Journal of Cardio-thoracic... Dec 2020Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During...
OBJECTIVES
Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During the pandemic, several complications have been shown to be associated with coronavirus disease 2019 (COVID-19). Our goal was to present a series of patients with COVID-19 who underwent chest tube placements due to the development of pleural complications and to make suggestions for the insertion and follow-up management of the chest tube.
METHODS
We retrospectively collected and analysed data on patients with laboratory-confirmed COVID-19 in our hospital between 11 March and 15 May 2020. Patients from this patient group who developed pleural complications requiring chest tube insertion were included in the study.
RESULTS
A total of 542 patients who were suspected of having COVID-19 were hospitalized. The presence of severe acute respiratory syndrome coronavirus 2 was confirmed with laboratory tests in 342 patients between 11 March and 15 May 2020 in our centre. A chest tube was used in 13 (3.8%) of these patients. A high-efficiency particulate air filter mounted double-bottle technique was used to prevent viral transmission.
CONCLUSIONS
In patients with COVID-19, the chest tube can be applied in cases with disease or treatment-related pleural complications. Our case series comprised a small group of patients, which is one of its limitations. Still, our main goal was to present our experience with patients with pleural complications and describe a new drainage technique to prevent viral transmission during chest tube application and follow-up.
Topics: Aftercare; Aged; COVID-19; Chest Tubes; Cross Infection; Drainage; Female; Follow-Up Studies; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Male; Middle Aged; Pandemics; Patient Safety; Pleural Diseases; Retrospective Studies; Treatment Outcome; Turkey
PubMed: 33164094
DOI: 10.1093/ejcts/ezaa356 -
Therapeutic Advances in Respiratory... 2018The use of biomarkers on pleural fluid (PF) specimens may assist the decision-making process and enhance clinical diagnostic pathways. Three paradigmatic examples are... (Review)
Review
The use of biomarkers on pleural fluid (PF) specimens may assist the decision-making process and enhance clinical diagnostic pathways. Three paradigmatic examples are heart failure, tuberculosis and, particularly, malignancy. An elevated PF concentration of the amino-terminal fragment of probrain natriuretic peptide (>1500 pg/ml) is a hallmark of acute decompensated heart failure. Adenosine deaminase, interferon-γ and interleukin-27 are three valuable biomarkers for diagnosing tuberculous pleurisy, yet only the first has been firmly established in clinical practice. Diagnostic PF biomarkers for malignancy can be classified as soluble-protein based, immunocytochemical and nucleic-acid based. Soluble markers (e.g. carcinoembryonic antigen (CEA), carbohydrate antigen 15-3, mesothelin) are only indicative of cancer, but not confirmatory. Immunocytochemical studies on PF cell blocks allow: (a) to distinguish mesothelioma from reactive mesothelial proliferations (e.g. loss of BAP1 nuclear expression, complemented by the demonstration of p16 deletion using fluorescence in situ hybridization, indicate mesothelioma); (b) to separate mesothelioma from adenocarcinoma (e.g. calretinin, CK 5/6, WT-1 and D2-40 are markers of mesothelioma, whereas CEA, EPCAM, TTF-1, napsin A, and claudin 4 are markers of carcinoma); and (c) to reveal tumor origin in pleural metastases of an unknown primary site (e.g. TTF-1 and napsin A for lung adenocarcinoma, p40 for squamous lung cancer, GATA3 and mammaglobin for breast cancer, or synaptophysin and chromogranin A for neuroendocrine tumors). Finally, PF may provide an adequate sample for analysis of molecular markers to guide patients with non-small cell lung cancer to appropriate targeted therapies. Molecular testing must include, at least, mutations of epidermal growth-factor receptor and BRAF V600E, translocations of rat osteosarcoma and anaplastic lymphoma kinase, and expression of programmed death ligand 1.
Topics: Biomarkers; Biomarkers, Tumor; Heart Failure; Humans; Pleural Diseases; Pleural Effusion; Pleural Effusion, Malignant; Tuberculosis, Pleural
PubMed: 30354850
DOI: 10.1177/1753466618808660 -
BMC Pulmonary Medicine Jul 2023Pleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in...
BACKGROUND
Pleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in diagnostic and therapeutic options, such as Indwelling Pleural Catheters (IPCs), have simplified PD treatment, allowing an effective outpatients management. Therefore, dedicated pleural services can improve PD care, guaranteeing specialized management and optimizing time and cost. We aimed to provide an overview on MPE management in Italy, mainly focused on distribution and characteristics of pleural services and IPCs use.
METHODS
A nationwide survey, endorsed by the Italian Thoracic Society, was distributed by email to members of selected subgroups in 2021.
RESULTS
Ninety (23%) members replied, most of whom being pulmonologists (91%). MPE resulted the most common cause of pleural effusion and was managed with heterogenous approaches, including talc pleurodesis via slurry (43%), talc poudrage (31%), repeated thoracentesis (22%) and IPCs insertion (2%). The setting of IPC insertion was inpatient care in 48% of cases, with a predominance of draining frequency every other day. IPC management mainly relied on caregivers (42%). The presence of a pleural service was reported by 37% of respondents.
CONCLUSIONS
The present study provides an extensive overview of MPE management in Italy, showing a highly heterogeneous approach, a scarce prevalence of out-patient pleural services, and a still limited adoption of IPCs, mainly due to lack of dedicated community care systems. This survey emphasizes the need of promoting a higher spreading of pleural services and an innovative healthcare delivery with more favourable cost-benefit ratio.
Topics: Humans; Pleural Effusion, Malignant; Talc; Pleura; Pleural Diseases; Italy
PubMed: 37430219
DOI: 10.1186/s12890-023-02530-4 -
The European Respiratory Journal Oct 1997Although infectious, inflammatory and neoplastic diseases frequently involve the pleural space and walls, little is known about the immunological and molecular... (Review)
Review
Although infectious, inflammatory and neoplastic diseases frequently involve the pleural space and walls, little is known about the immunological and molecular mechanisms underlying pleural disorders. This article provides an overview of recent insights into immunobiological processes likely to play a role in the pathogenesis of pleural disorders. Pleural involvement in certain diseases is associated with the infiltration of a number of different types of immune cells, such as neutrophils, eosinophils or lymphocytes, in various proportions depending on both the course and the aetiology of the underlying disease. In addition to infiltrating cells, mesothelial cells have been demonstrated to actively participate in pleural inflammation via release of various mediators and proteins, including platelet-derived growth factor (PDGF), interleukin-8, monocyte chemotactic peptide (MCP-1), nitric oxide (NO), collagen, antioxidant enzymes and the plasminogen activation inhibitor (PAI). Furthermore, several inflammatory mediators have been detected at increased concentrations within pleural effusions, including lipid mediators, cytokines and proteins (adenosine deaminase, lysosyme, eosinophil-derived cationic proteins, and products of the coagulation cascade). The presence of these mediators underline the concept of pleural inflammation, and certain cytokines seem to characterize a specific aetiology of pleurisy. The understanding of these processes and the sequence of events leading to pleural loculation, pleural adhesion or repair are likely to provide the basis for early therapeutic intervention and reduce pleural-associated morbidity.
Topics: Cells, Cultured; Humans; Pleura; Pleural Neoplasms; Pleurisy; Pleurodesis; Tuberculosis, Pleural
PubMed: 9387973
DOI: 10.1183/09031936.97.10102411 -
Internal Medicine (Tokyo, Japan) Jul 2021We herein report a rare case of a 66-year-old man with refractory chylothorax. Although he had been treated with moderate doses of prednisolone (PSL) on suspicion of... (Review)
Review
We herein report a rare case of a 66-year-old man with refractory chylothorax. Although he had been treated with moderate doses of prednisolone (PSL) on suspicion of pleuritis with Sjögren syndrome, the pleural effusion expanded after the reduction of PSL. Further workup including histopathological examinations of pleura led to the diagnosis of IgG4-RD with bilateral chylothorax without any leakage from the thoracic duct. Combination therapy with high-dose PSL plus rituximab successfully decreased the pleural effusion. This is a very rare case of IgG4-related pleuritis with chylothorax and the first report of its successful treatment with rituximab.
Topics: Aged; Chylothorax; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Male; Pleura; Pleural Effusion; Pleurisy
PubMed: 33518567
DOI: 10.2169/internalmedicine.6313-20 -
Pulmonary Medicine 2018Clinical pathways are evidence based multidisciplinary team approaches to optimize patient care. Pleural diseases are common and accounted for 3.4 billion US $ in 2014... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Clinical pathways are evidence based multidisciplinary team approaches to optimize patient care. Pleural diseases are common and accounted for 3.4 billion US $ in 2014 US inpatient aggregate charges (HCUPnet data). An institutional clinical pathway ("pleural pathway") was implemented in conjunction with a dedicated pleural service. Design, implementation, and outcomes of the pleural pathway (from August 1, 2014, to July 31, 2015) in comparison to a previous era (from August 1, 2013, to July 31, 2014) are described.
METHODS
Tuality Healthcare is a 215-bed community healthcare system in Hillsboro, OR, USA. With the objective of standardizing pleural disease care, locally adapted British Thoracic Society guidelines and a centralized pleural service were implemented in the era. System-wide consensus regarding institutional guidelines for care of pleural disease was achieved. Preimplementation activities included training, acquisition of ultrasound equipment, and system-wide education. An audit database was set up with the intent of prospective audits. An administrative database was used for harvesting outcomes data and comparing them with the era.
RESULTS
54 unique consults were performed. A total of 55 ultrasound examinations and 60 pleural procedures were performed. All-cause inpatient pleural admissions were lower in the "pathway" era ( = 9) compared to the "prior to pathway" era ( = 17). Gains in average case charges (21,737$ versus 18,818.2$/case) and average length of stay (3.65 versus 2.78 days/case) were seen in the "pathway" era.
CONCLUSION
A "pleural pathway" and a centralized pleural service are associated with reduction in case charges, inpatient admissions, and length of stay for pleural conditions.
Topics: Aged; Critical Pathways; Female; Humans; Length of Stay; Male; Middle Aged; Pleural Diseases; Retrospective Studies; Treatment Outcome
PubMed: 29805807
DOI: 10.1155/2018/2035248 -
Occupational and Environmental Medicine Jun 1997To determine predictors of progression of pleural and parenchymal disease on the chest radiographs of workers exposed to a short term, intense exposure of amosite...
OBJECTIVES
To determine predictors of progression of pleural and parenchymal disease on the chest radiographs of workers exposed to a short term, intense exposure of amosite asbestos.
METHODS
The first and last of a series of chest radiographs of 887 workers exposed to amosite was interpreted and coded according to International Labour Organisation (ILO) standards by two physicians. Significant predictors of disease progression were found by a linear stepwise regression analysis from among such variables as smoking history, latency (time since first exposure), duration and intensity of exposure, and cytology.
RESULTS
Although most radiographs remained normal, some showed progression of disease with about twice as many patients with abnormalities on the last film. Various combinations of age, intensity of exposure, and time between films were significant predictors of pleural and parenchymal disease and progression of such disease. No predominance of one sided disease was noted. Cytology and smoking were unreliable predictors of disease. Most disease progression was minor, usually of less than two scoring categories.
CONCLUSION
An intense, yet short, exposure to amosite asbestos can produce pleural and parenchymal changes on chest radiographs. The number of those affected roughly doubled over a period spanning 10 to 20 years after exposure. Age and intensity of exposure are the most important predictors of disease.
Topics: Adult; Age Factors; Asbestos, Amosite; Calcinosis; Cohort Studies; Disease Progression; Female; Follow-Up Studies; Humans; Lung Diseases; Male; Occupational Exposure; Pleural Diseases; Radiography; Regression Analysis; Risk Factors; Severity of Illness Index; United States
PubMed: 9245947
DOI: 10.1136/oem.54.6.410