Ultrasound-Guided Pleural Investigations
Pleural diseases are frequently encountered across multiple inpatient and outpatient settings, making pleural drainage and sampling one of the most common medical procedures. With the widespread adoption of bedside ultrasound examination, ultrasound machines are now readily available in many clinical settings, providing both diagnostic and procedural guidance. The modern management of pleural disease is dominated by ultrasound assessment with strong evidence supporting its use to guide pleural interventions. Here, we review the current landscape of ultrasound use to guide pleural drainage, pneumothorax management, and pleu...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Jeffrey Thiboutot, Kyle T. Bramley Source Type: research
Pleural Fluid Analysis
Fifty years from their initial description, Light ’s criteria are still unhesitatingly accepted as the default reference test for separating pleural transudates and exudates. Efforts should be focused not so much on trying to find an even more reliable technique for categorizing PEs but on improving the misclassification rate of transudates that characterize Light’s criteria. Despite their shortcomings, Light’s criteria may well continue their reign for another 50 years. Long live the Light’s criteria! (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Jos é M. Porcel, Richard W. Light Source Type: research
Setting up a Pleural Disease Service
Pleural disease incidence is continuing to rise internationally and management is becoming increasingly complex. There are now many more options for patients, with access to thoracic ultrasound, image-guided biopsies, indwelling pleural catheters, and local-anesthetic pleuroscopy (thoracoscopy). Safety reports have also highlighted the need for specialist operator knowledge and skill. Consequently, the development of a specialized pleural service can manage patients entirely as an outpatient, limit the number of procedures, and improve patient safety, it also fosters opportunities to enhance specialist procedural skills, e...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Helen McDill, Nick Maskell Source Type: research
Hepatic Hydrothorax and Congestive Heart Failure Induced Pleural Effusion
Pleural effusions (PEs) are frequently encountered in routine clinical practice, affecting more than 3000 people per million population every year. Heart and liver failures are two of the most common causes of transudative PE. Because these effusions have nonmalignant etiologies, they are commonly referred to as benign effusions despite of the poor prognosis they foretell in their refractory stages. Like malignant effusions, symptom management is important and plays a significant role in palliation when these effusions become refractory to medical therapy. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Shaikh M. Noor Husnain, Samira Shojaee Source Type: research
Parapneumonic Effusion and Empyema
The rising incidence and high morbidity of pleural infection remain a significant challenge to health care systems worldwide. With distinct microbiology and treatment paradigms from pneumonia, pleural infection is an area in which the evidence base has been rapidly evolving. Progress in recent years has revolved around characterizing the microbiome of pleural infection and the addition of new strategies such as intrapleural enzyme therapy to the established treatment pathway of drainage and antibiotics. The future of improving outcomes lies with personalizing treatment, establishing optimal timing of intrapleural agents an...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Dinesh N. Addala, Eihab O. Bedawi, Najib M. Rahman Source Type: research
Pleural Tuberculosis
Pleural tuberculosis (TB) is common and often follows a benign course but may result in serious long-term morbidity. Diagnosis is challenging because of the paucibacillary nature of the condition. Advances in Mycobacterium culture media and PCR-based techniques have increased the yield from mycobacteriologic tests. Surrogate biomarkers perform well in diagnostic accuracy studies but must be interpreted in the context of the pretest probability in the individual patient. Confirming the diagnosis often requires biopsy, which may be acquired through thoracoscopy or image-guided closed pleural biopsy. Treatment is standard ant...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Jane A. Shaw, Coenraad F.N. Koegelenberg Source Type: research
Chylothorax and Pseudochylothorax
Classically, both chylothorax and pseudochylothorax present as a pleural effusion with a characteristic milky white appearance to the pleural fluid. Although both are rare causes of pleural effusion, they have distinct etiologies and clinical implications, and as a result require different management strategies. Pleural fluid analysis of cholesterol and triglyceride levels is key to differentiating the 2 entities from one another and then guide the clinician to determine the best next steps in evaluation and management. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Cassandra M. Braun, Jay H. Ryu Source Type: research
Malignant Pleural Effusions
This article focuses on the diagnosis and management of malignant pleural effusion. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Christopher M. Kapp, Hans J. Lee Source Type: research
Anatomy and Applied Physiology of the Pleural Space
The unique anatomy and physiology of the pleural space provides tight regulation of liquid within the space under normal physiologic conditions. When this balance is disrupted and pleural effusions develop, there can be significant impacts on the respiratory system. Drainage of effusions can lead to meaningful improvement in symptoms, primarily owing to improvement in the length –tension relationship of the respiratory muscles. Ultrasound examination to evaluate the movement and function of the diaphragm, as well as pleural manometry, have provided a greater understanding of the impact of pleural effusion and thoracentes...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Erin M. DeBiasi, David Feller-Kopman Source Type: research
Malignant Pleural Mesothelioma
Malignant mesothelioma is the result of neoplastic transformation of the mesothelial cells, with more than 80% arising from the pleura. The global incidence of mesothelioma continues to rise. Although the number of cases in developed countries has remained stable, the World Health Organization predicts an exponential increase in mesothelioma cases in developing regions, where underreporting of mesothelioma is also common, due to unregulated use of asbestos.1 –7 (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Calvin Sidhu, Amber Louw, Y.C. Gary Lee Source Type: research
Pneumothorax
is a common problem worldwide. Pneumothorax develops secondary to diverse aetiologies; in many cases, there may be no recognizable lung abnormality. The pathogenetic mechanism(s) causing spontaneous pneumothorax may be related to an interplay between lung-related abnormalities and environmental factors such as smoking. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax; chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax. This review article provides an overview of the historical perspective, epidemiology, classification, and aetiology of pne...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Nai-Chien Huan, Calvin Sidhu, Rajesh Thomas Source Type: research
Management of Pneumothorax
Pneumothorax is a common medical condition encountered in a wide variety of clinical presentations, ranging from asymptomatic to life threatening. When symptomatic, it is important to remove air from the pleural space and provide re-expansion of the lung. Additionally, patients who experience a spontaneous pneumothorax are at high risk for recurrence, so treatment goals also include recurrence prevention. Several recent studies have evaluated less invasive management strategies for pneumothorax, including conservative or outpatient management. Future studies may help to identify who is greatest at risk for recurrence and d...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Andrew DeMaio, Roy Semaan Source Type: research
Indwelling Pleural Catheters
Recurrent, symptomatic pleural effusions are common and can contribute to significant morbidity in affected patients. Various management options are available and indwelling pleural catheter placement is becoming more commonplace and is the preferred option in certain clinical scenarios. The body of literature pertaining to indwelling pleural catheter use has grown substantially over the last decade and the purpose of this review is to summarize the best available evidence. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Audra J. Schwalk, David E. Ost Source Type: research
Medical Thoracoscopy
Medical thoracoscopy is an effective and safe modality to visualize and sample contents of the pleural cavity. It is an outpatient procedure that can be performed while the patient is spontaneously breathing, with the use of local anesthesia and intravenous medications for sedation and analgesia. Medical thoracoscopy has indications in the management of a variety of pleural diseases. It is most commonly performed as a diagnostic procedure but has therapeutic applications as well. Although it has its advantages, management strategies of certain pleural diseases should take place within a multidisciplinary environment includ...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Sameer K. Avasarala, Robert J. Lentz, Fabien Maldonado Source Type: research
Joining Forces
This article details the pros, cons, challenges/pitfalls, and elements required for the successful conduct of multicenter randomized trials, with specific focus on trials related to pleural diseases. Several networks dedicated to the multicenter study of important pleural conditions have developed, yielding practice-changing studies in pleural disease. This review describes the importance of multicenter trials, major elements required for the conduct of such trials, and lessons learned from the ongoing development of the Interventional Pulmonary Outcomes Group, a consortium of interventional pulmonologists dedicated to adv...
Source: Clinics in Chest Medicine - November 11, 2021 Category: Respiratory Medicine Authors: Lance Roller, Lonny B. Yarmus, Robert J. Lentz Source Type: research
