Ultrasound-based elastography: "hard" to implement in the pleural effusion work-up?

Thoracic ultrasound (TUS) has been incorporated as a routine bedside tool for the diagnosis of pleural diseases and the performance of safe pleural procedures [1]. It is generally accepted that TUS can provide valuable information on the possible malignant nature of a pleural effusion. Ultrasound appearances suggestive of malignancy include parietal or visceral pleural thickening of more than 1 cm, diaphragmatic thickness greater than 7 mm, pleural or diaphragmatic nodules and liver metastases, but the sonographic fluid characteristics themselves are nonspecific [2, 3]. These imaging criteria, also applicable to computed tomography [4], are highly specific and moderately sensitive when considered in combination. Accuracy data may be influenced by the overrepresentation of certain aetiologies, such as mesotheliomas (increases sensitivity) and tuberculosis (decreases specificity), in the study population. While conventional TUS reports morphological findings, ultrasound elastography provides stiffness information, which can also be potentially used for diagnostic purposes as the study by Jiang et al. [5] demonstrates in this issue of the European Respiratory Journal.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Editorials Source Type: research

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1332Objectives: To investigate the value of 18F-FDG PET/CT imaging in differentiating malignant from benign exudative pleural effusions. Methods: 224 patients with CT scan and pleural effusion puncture examination evidence of moderate or massive exudative pleural effusions entered the study to evaluate the accuracy of 18F-FDG PET/CT in differential diagnosis between malignant and benign exudative pleural effusions. Image analysis of PET/CT was performed both with visual interpretation and using a quantitative method on coronal, sagittal and axial reconstructions. The results of PET/CT imaging were compared to cyto- or hist...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Lung Cancer Posters Source Type: research
Authors: Duranti L, Pardolesi A, Bertolaccini L, Tavecchio L, Scanagatta P, Rolli L, Pastorino U Abstract The extra-pleural pneumonectomy (EPP) is a standardised surgical procedure born for pleural tuberculosis and later used in pleural cancer treatment, especially in malignant pleural mesothelioma (MPM). This systematic review aimed to focus on the actual overall EPP role in surgical oncology. The literature search was performed from January 1985 to January 2018 In PubMed, Embase, and Cochrane according to PRISMA protocol. The search was restricted to publications in English with the research words "extrapleu...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Morphological appearance of Pleural nodules during thoracoscopy are not 100% diagnostic of Malignancy or TB. An early definite etiological diagnosis will help to decide the further treatment plan.Methods: During Medical thoracoscopy, Pulmonologist prepared Cytology smears slides directly from parietal pleura nodule biopsy tissue. Cytologist provided the smear cytology results in one day. Data were retrospectively reviewed, and Cytology results were compared with final pleural biopsy histopathology report.Results: 40 patients underwent Medical thoracoscopy for undiagnosed pleural effusion at a tertiary care hospital in Sout...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional Pulmonology Source Type: research
Authors: Carlucci P, Trigiani M, Mori PA, Mondoni M, Pinelli V, Casalini AG, Conte EG, Buggio G, Villari L, Marchetti G Abstract Diseases of the pleura and pleural space are common and present a significant contribution to the workload of respiratory physicians, accounting for an annual incidence of more than 1.5 million cases in the US with the majority of cases resulting from congestive heart failure, pneumonia, and cancer 1. Although the radiographic and ultrasonographic detection of pleural abnormalities may be obvious, the determination of a specific diagnosis can often represent a challenge. Since pleural eff...
Source: Panminerva Medica - Category: General Medicine Tags: Panminerva Med Source Type: research
Abdominal ascites is most commonly caused by portal hypertension from liver cirrhosis. When present, portal hypertension is associated with an elevated serum-ascites albumin gradient (SAAG) ≥1.1 g/dL. In contrast, a SAAG #x3c; 1.1 g/dL suggests malignancy, tuberculosis, pancreatitis, or nephrotic syndrome. Here, we present a case of low SAAG ascites caused by epithelioid peritoneal mesothelioma in a woman with no known liver disease. The diagnosis proved elusive until diagnostic lapa roscopy with biopsy was performed.Case Rep Gastroenterol 2018;12:420 –424
Source: Case Reports in Gastroenterology - Category: Gastroenterology Source Type: research
Excerpted fromPrecision Medicine and the Reinvention of Human DiseaseDespite having the most advanced healthcare technology on the planet, life expectancy in the United States is not particularly high. Citizens from most of the European countries and the highly industrialized Asian countries enjoy longer life expectancies than the United States. According to the World Health Organization, the United States ranks 31st among nations, trailing behind Greece, Chile, and Costa Rica, and barely edging out Cuba [42]. Similar rankings are reported by the US Central Intelligence Agency [43]. These findings lead us to infer that acc...
Source: Specified Life - Category: Information Technology Tags: cancer cancer vaccines precision medicine prevention public health Source Type: blogs
Conclusions: The overlap of pleural VEGF levels between the groups may limit the value of VEGF in discriminating between malignant versus benign and exudative versus transudative effusions; however, it may be a useful adjunct to various methods. The VEGF levels in pleural fluid seem to be related to the degree of inflammation and pleural invasion.
Source: Nigerian Journal of Clinical Practice - Category: Rural Health Authors: Source Type: research
We describe the case of a 67-year-old patient, a retired person, without significant personal or familial history, nonsmoker, infrequent alcohol and coffee consumer with following chief complaints at onset: loss of appetite, weight loss, serious physical asthenia, delayed intestinal transit, diffuse abdominal pain and increase of abdominal circumference. Initially was misdiagnosed with liver cirrhosis. After discharged from our Clinic, suspicion of diagnosis was mesothelioma as well as after first thoracoscopy and pleural biopsy performed in a Clinic of Thoracic Surgery. Several pleural fragments collected by biopsy were s...
Source: Romanian Journal of Morphology and Embryology - Category: General Medicine Tags: Rom J Morphol Embryol Source Type: research
Publication date: Available online 17 June 2017 Source:Revista Clínica Española (English Edition) Author(s): F. Rodriguez-Panadero Pleural biopsies are especially indicated in the following circumstances: (a) inconclusive pleural fluid analysis and negative sputum study, if adenosine deaminase (ADA) levels are unavailable; (b) suspected multi-resistant tuberculosis; (c) a need for differentiating tuberculous pleurisy (if it progresses with neutrophilia) and complicated parapneumonic effusion; (d) malignant pleural effusion coexisting with very high ADA levels; (e) effusion coexisting with lung cancer and neg...
Source: Revista Clinica Espanola - Category: Internal Medicine Source Type: research
We present a retrospective study of 25 patients with spontaneous pneumothorax (three recurrent), comprising 16 Saudis (nine males and seven females) and nine non-Saudis (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of the patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan, and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient), and congenital bullae (one patient) constituted the eti...
Source: Annals of Saudi Medicine - Category: General Medicine Tags: ISSUE 3 Source Type: research
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