Diagnostics in Pleural Disease (original) (raw)
Related papers
Diagnostic approach to pleural diseases: new tricks for an old trade
F1000Research, 2017
The burden of pleural diseases has substantially increased in the past decade because of a rise in the incidence of pleural space infections and pleural malignancies in a patient population that is older and more immunocompromised and has more comorbidities. This complexity increasingly requires minimally invasive diagnostic options and tailored management. Implications for patients are such that the limitations of current diagnostic methods need to be addressed by multidisciplinary teams of investigators from the fields of imaging, biology, and engineering. Ignored for a long time as an epiphenomenon at the crossroad of many unrelated medical problems, pleural diseases are finally getting the attention they deserve and have spurred a vibrant and exciting field of research.
Efficacy of Pleural Brush Cytology in the Diagnosis of Pleural Diseases
Indian Journal of Respiratory Care
The accurate diagnosis of pleural effusion remains a challenging clinical problem because even after thoracentesis and closed pleural biopsy, 15%-20% of pleural effusions still remain undiagnosed. [1] In order to get a pleural biopsy for the diagnosis of undiagnosed pleural effusion, several techniques are used such as percutaneous needle pleural biopsy, computed tomography (CT)-guided pleural biopsy, medical thoracoscopy, video-assisted thoracoscopy, and open thoracotomy. Medical thoracoscopy can be used to describe the diagnostic and therapeutic exploration of the pleural space. Medical thoracoscopy has an established role in diagnosing the etiology of pleural effusion. Although thoracoscopic-guided pleural biopsy provides good yield, it has a limitation of delayed results by 5-7 days. Pleural brushings can be obtained using bronchoscopy brush through the working channel of rigid thoracoscope. The hypothesis was that results of cytology will be available earlier and if these results are concordant with pleural biopsy, early institution of therapy may be facilitated. PatIents and Methods The study was approved by the Institutional Ethics Committee. This prospective study was done from December 2015 to June 2017. The study participants comprised of consecutive patients in whom the etiology of pleural effusion remained undiagnosed despite routine investigations of pleural fluid such as cell count, adenosine deaminase, lactate dehydrogenase, sugar, protein, cytology, and polymerase chain reaction. Patients with excess rib crowding, bleeding diathesis, hemodynamic instability, and arrhythmias were not included in this study. Medical thoracoscopy was performed through a single puncture technique using a rigid thoracoscope. The procedure was done with complete aseptic precaution under local anesthesia, conscious sedation, and potent analgesia. The patients were placed in the lateral decubitus position
Medical thoracoscopy and its evolving role in the diagnosis and treatment of pleural disease
Journal of Thoracic Disease
Establishing the etiology of exudative pleural effusions in the setting of an unrevealing pleural fluid analysis often requires biopsies from the parietal pleura. While closed pleural biopsy (CPB) has been a popular minimally-invasive approach, it has a poor diagnostic yield, barring a diagnosis of tuberculous pleurisy. Medical thoracoscopy (MT) is a minimally-invasive ambulatory procedure performed under local anesthesia or moderate sedation which allows for direct visualization of biopsy targets as well as simultaneous therapeutic interventions, including chemical pleurodesis and indwelling tunneled pleural catheter (ITPC) placement. The excellent yield and favorable safety profile of MT has led to it replacing CPB for many indications, particularly in the management of suspected malignant pleural effusions. As experience with MT amongst interventional pulmonologists has grown, there is an increased appreciation for its important role alongside percutaneous and surgical approaches in the diagnosis and treatment of pleural disease.
Role of Chest Ultrasound in Assessment of Different Pleural Lesions
IOSR Journals , 2019
Background: Ultrasound is useful in lung and pleural evaluation due to its real-time response characteristics. Add to that, its portability, bedside availability and absence of ionizing radiation; therefore, it is a safe technique for all patients. It can evaluate abnormalities in the peripheral lung parenchyma, pleura and chest wall. It may also be used to guide invasive procedures, such as pleural puncture, biopsy and chest tube insertion.Aim of the Work: to evaluate the role of ultrasound for diagnosis and assessment of different pleural lesions and the possibility to differentiate between benign and malignant pleural diseases. Patients and methods: This study was conducted on 30 patients. They were referred to radiology department at National cancer institute and Ain Shams University hospitals with different pleural lesionsbetween May and December of 2018. Results:Compared to CT scans, US is easier to perform and may better differentiate between pleural thickening and pleural effusion. Besides, it could detect very low amounts of effusion, as low as 3-5 ml of fluid. Chest ultrasound also served a role in tissue characterization through identifying morphology of growth in forms of non-uniformity of the pleura and heterogeneity of different tissues. Conclusion: Pleural ultrasound was a reliable tool in evaluation of different aspects of pleural growth and neoplasia, detection of the extent of spread to the chest wall and diaphragm in neoplastic lesions and predicting the nature of the pleural effusion through detecting internal echoes and septations.
The Role of Thoracoscopy in Diagnosis and Treatment of Pleural Disease
World Journal of Laparoscopic Surgery with DVD, 2012
Intrathoracic disease involving lungs and pleura encountered frequently and remains a challenging clinical problem. The definitive diagnosis of lung or pleural disease some times remain unclear despite thoracocentesis, closed pleural biopsy, transthoracic needle aspiration or bronchoscopy. Recent advances in endoscopic technique, video equipment and development of better instrumentation have contributed to the resurgence of thoracoscopy as a diagnostic and thoracoscopic modality.
Journal of Fatima Jinnah Medical University, 2020
Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard. Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology OPD-Gulab Devi Te...
Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases
Journal of Ultrasound, 2008
Although numerous studies have been conducted on the use of ultrasonography (US) for the examination of thoracic structures, this procedure is not as widely accepted as abdominal US. The newer portable scanners can be used at the bedside to detect pleural malignancies and effusions, as well as peripheral lung nodules of the lung, even in seriously ill patients. Focal thickening of the pleura can be easily detected with US and further investigated with a US-guided biopsy. US guidance can also be used during percutaneous drainage of pleural effusion or transthoracic biopsy of peripheral lung lesions, thus reducing the incidence of procedure-related pneumothorax to almost zero. We review the current literature on thoracic US and present our clinical experience with the technique in large groups of patients with pleural and peripheral lung diseases.
BMJ open respiratory research, 2017
Malignant pleural effusion (MPE) is common and currently in UK there are an estimated 50 000 new cases of MPE per year. Talc pleurodesis remains one of the most popular methods for fluid control. The value of thoracic ultrasound (TUS) imaging, before and after pleurodesis, in improving the quality and efficacy of care for patients with MPE remains unknown. Additionally, biomarkers of successful pleurodesis including measurement of pleural fluid proteins have not been validated in prospective studies.The SIMPLE trial is an appropriately powered, multicentre, randomised controlled trial designed to assess 'by the patient bedside' use of TUS imaging and pleural fluid analysis in improving management of MPE. 262 participants with a confirmed MPE requiring intervention will be recruited from hospitals in UK and The Netherlands. Participants will be randomised (1:1) to undergo either chest drain insertion followed by instillation of sterile talc, or medical thoracoscopy and simult...
The Role Of Ultrasonography In The Diagnosis Of Pleural Disorders
2013
Ultrasonography of pleural space is playing an increasingly great role in the diagnosis of panoply of pleural disorders. In fact, ultrasonography is a reliable and simple procedure, free from side effects, non invasive and painless. Its reliability has been contradicted mainly because of the non-specific data gathered, but plain chest radiographies, so largely used, do not offer a higher specificity or sensitivity. It remains however valid the fact that ultrasonography of pleural space has to be made from a well trained imaging specialist, able of contouring and separating anatomical structures and changes found herein. A summary of other imaging procedures is discussed as well, with computerized tomography, magnetic resonance imaging and nuclear imaging procedures offering other possibilities, but lacking overall availability and immediate applicability.
Egyptian Journal of Chest Diseases and Tuberculosis, 2016
Background: Medical thoracoscopy increases the diagnostic yield in patients with undiagnosed pleural effusion. Ultrasound guided pleural biopsies are safe procedures with high diagnostic yields. Objective: To compare safety and efficacy of medical thoracoscopic versus ultrasound guided transthoracic needle biopsy in the diagnosis of pleural lesions. Patients and methods: 40 patients with undiagnosed pleural lesions were divided into 2 groups. After clinical, radiological examination and laboratory investigations; pleural biopsies were taken by ultrasound guided needle biopsy and medical thoracoscopy in group I and II respectively. Results: Complications in group I were in the form of pain in 2 patients (10%), hemoptysis in 1 (5%), while complications in group II were pain in 4 (20%), failure of the lung to expand in 5 (25%), pneumothorax in 5 (25%) and wound infection in 3 patients (15%). Final histopathological diagnosis in group I was parapneumonic effusion in 3 patients (15%), inflammatory lung lesion in 1 (5%), pleural fibroma in 2 (10%), malignant mesothelioma in 4 (20%), sarcoma in 1 (5%), adenocarcinoma in 1 (5%), squamous cell carcinoma in 4 (20%), and metastatic adenocarcinoma in 1 (5%). Final histopathological diagnosis in group II was pleural TB in 4 patients (20%), inflammatory lung lesions in 2 (10%), malignant mesothelioma in 6 (30%), adenocarcinoma in 5 (25%), and metastatic adenocarcinoma in 2 (10%). The diagnosed cases were 17 (85%) and 19 (95%) in groups I and II respectively. Conclusions: Medical thoracoscopy is an important diagnostic method for the diagnosis of undiagnosed pleural effusion while it is concluded that US guided pleural biopsy is more useful in cases of pleural lesions without effusion.