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Tejani A, Dowling T, Sanampudi S, Yazdani R, Canan A, Malja E, Xi Y, Abbara S, Peshock RM, Kay FU. Deep Learning for Detection of Pneumothorax and Pleural Effusion on Chest Radiographs: Validation Against Computed Tomography, Impact on Resident Reading Time, and Interreader Concordance. J Thorac Imaging 2024; 39:185-193. [PMID: 37884394 DOI: 10.1097/rti.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE To study the performance of artificial intelligence (AI) for detecting pleural pathology on chest radiographs (CXRs) using computed tomography as ground truth. PATIENTS AND METHODS Retrospective study of subjects undergoing CXR in various clinical settings. Computed tomography obtained within 24 hours of the CXR was used to volumetrically quantify pleural effusions (PEfs) and pneumothoraxes (Ptxs). CXR was evaluated by AI software (INSIGHT CXR; Lunit) and by 3 second-year radiology residents, followed by AI-assisted reassessment after a 3-month washout period. We used the area under the receiver operating characteristics curve (AUROC) to assess AI versus residents' performance and mixed-model analyses to investigate differences in reading time and interreader concordance. RESULTS There were 96 control subjects, 165 with PEf, and 101 with Ptx. AI-AUROC was noninferior to aggregate resident-AUROC for PEf (0.82 vs 0.86, P < 0.001) and Ptx (0.80 vs 0.84, P = 0.001) detection. AI-assisted resident-AUROC was higher but not significantly different from the baseline. AI-assisted reading time was reduced by 49% (157 vs 80 s per case, P = 0.009), and Fleiss kappa for Ptx detection increased from 0.70 to 0.78 ( P = 0.003). AI decreased detection error for PEf (odds ratio = 0.74, P = 0.024) and Ptx (odds ratio = 0.39, P < 0.001). CONCLUSION Current AI technology for the detection of PEf and Ptx on CXR was noninferior to second-year resident performance and could help decrease reading time and detection error.
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Affiliation(s)
- Ali Tejani
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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Metintas M, Ak G, Yildirim H, Dundar E, Aydin N, Erginel S, Alatas F, Yilmaz S, Metintas S. Image-Assısted Pleural Needle Biopsy or Medical Thoracoscopy: Which Method for Which Patient? - A Randomızed Controlled Trial. Chest 2024:S0012-3692(24)00427-6. [PMID: 38554817 DOI: 10.1016/j.chest.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Image-guided or assisted needle biopsies and the increasing use of medical thoracoscopy (MT) have increased the diagnostic accuracy of pleural diseases significantly. However, no consensus exists regarding which patients with pleural effusion should undergo MT and which patients should undergo image-guided or assisted needle biopsy as the first procedure to ensure greater diagnostic accuracy. RESEARCH QUESTION Which biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion? STUDY DESIGN AND METHODS This prospective, randomized, parallel study included 228 patients with undiagnosed exudative pleural effusion. Patients were divided into two groups based on CT scan findings. Group 1 included patients with pleural effusion only. Group 2 included patients with pleural thickening or lesion in addition to pleural effusion. Patients in each group were assigned randomly to an image-assisted Abrams needle biopsy (IA-ANPB) or MT arm. The diagnostic sensitivity, reliability, and safety were determined for both groups. RESULTS The false-negative rate was 30.3% for the IA-ANPB arm and 3.1% for the MT arm in group 1. The same rates were 11.9% for IA-ANPB and 4.7% for MT in group 2. In group 1, the sensitivity for the IA-ANPB arm was 69.7%, and the negative likelihood ratio was 0.30. The same rates for the MT arm were 96.9% and 0.03 (P = .009). In group 2, these values were 88.1% and 0.12 for the IA-ANPB arm and 95.4% and 0.05 for the MT arm (P = .207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; P = .107). INTERPRETATION MT showed a high diagnostic success in all patients with pleural fluid. However, IA-ANPB showed similar diagnostic success as MT in patients with pleural effusion and associated pleural thickening or lesions. Therefore, in the latter case, IA-ANPB could be preferable to MT. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT05428891; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Muzaffer Metintas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey; Lung and Pleural Cancers Clinical and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Guntulu Ak
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey; Lung and Pleural Cancers Clinical and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Huseyin Yildirim
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Emine Dundar
- Department of Pathology, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Nevin Aydin
- Department of Radiology, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sinan Erginel
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Fusun Alatas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Senay Yilmaz
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Selma Metintas
- Department of Public Health, Eskisehir Osmangazi University Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
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Gonnelli F, Hassan W, Bonifazi M, Pinelli V, Bedawi EO, Porcel JM, Rahman NM, Mei F. Malignant pleural effusion: current understanding and therapeutic approach. Respir Res 2024; 25:47. [PMID: 38243259 PMCID: PMC10797757 DOI: 10.1186/s12931-024-02684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality and elevated costs to healthcare systems. Over the last decades the understanding of pathophysiology mechanisms, diagnostic techniques and optimal treatment intervention in MPE have been greatly advanced by recent high-quality research, leading to an ever less invasive diagnostic approach and more personalized management. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. In the next future, because of a better understanding of underlying tumor biology together with more sensitive molecular diagnostic techniques, it is likely that combined diagnostic and therapeutic procedures allowing near total outpatient management of MPE will become popular. This article provides a review of the current advances, new discoveries and future directions in the pathophysiology, diagnosis and management of MPE.
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Affiliation(s)
- Francesca Gonnelli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | - Wafa Hassan
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | | | - Eihab O Bedawi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - José M Porcel
- Research Group of Cancer Biomarkers, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova, University Hospital, Lleida, Spain
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Unit, Oxford, UK
- Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy.
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Wei M, Zhang Y, Zhao L, Zhao Z. Development and validation of a radiomics nomogram for diagnosis of malignant pleural effusion. Discov Oncol 2023; 14:213. [PMID: 37999794 PMCID: PMC10673775 DOI: 10.1007/s12672-023-00835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to develop a radiomics nomogram based on computed tomography (CT) scan features and high-throughput radiomics features for diagnosis of malignant pleural effusion (MPE). METHODS In this study, 507 eligible patients with PE (207 malignant and 300 benign) were collected retrospectively. Patients were divided into training (n = 355) and validation cohorts (n = 152). Radiomics features were extracted from initial unenhanced CT images. CT scan features of PE were also collected. We used the variance threshold algorithm and least absolute shrinkage and selection operator (LASSO) to select optimal features to build a radiomics model for predicting the nature of PE. Univariate and multivariable logistic regression analyzes were used to identify significant independent factors associated with MPE, which were then included in the radiomics nomogram. RESULTS A total of four CT features were retained as significant independent factors, including massive PE, obstructive atelectasis or pneumonia, pleural thickening > 10 mm, and pulmonary nodules and/or masses. The radiomics nomogram constructed from 13 radiomics parameters and four CT features showed good predictive efficacy in training cohort [area under the curve (AUC) = 0.926, 95% CI 0.894, 0.951] and validation cohort (AUC = 0.916, 95% CI 0.860, 0.955). The calibration curve and decision curve analysis showed that the nomogram helped differentiate MPE from benign pleural effusion (BPE) in clinical practice. CONCLUSION This study presents a nomogram model incorporating CT scan features and radiomics features to help physicians differentiate MPE from BPE.
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Affiliation(s)
- Mingzhu Wei
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China.
- Department of Radiology, Shaoxing People's Hospital, No. 568, Zhongxing North Road, Yuecheng District, Shaoxing, 312000, Zhejiang, People's Republic of China.
| | - Yaping Zhang
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Li Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
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Tinè M, Daverio M, Semenzato U, Cocconcelli E, Bernardinello N, Damin M, Saetta M, Spagnolo P, Balestro E. Pleural clinic: where thoracic ultrasound meets respiratory medicine. Front Med (Lausanne) 2023; 10:1289221. [PMID: 37886366 PMCID: PMC10598727 DOI: 10.3389/fmed.2023.1289221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Thoracic ultrasound (TUS) has become an essential procedure in respiratory medicine. Due to its intrinsic safety and versatility, it has been applied in patients affected by several respiratory diseases both in intensive care and outpatient settings. TUS can complement and often exceed stethoscope and radiological findings, especially in managing pleural diseases. We hereby aimed to describe the establishment, development, and optimization in a large, tertiary care hospital of a pleural clinic, which is dedicated to the evaluation and monitoring of patients with pleural diseases, including, among others, pleural effusion and/or thickening, pneumothorax and subpleural consolidation. The clinic was initially meant to follow outpatients undergoing medical thoracoscopy. In this scenario, TUS allowed rapid and regular assessment of these patients, promptly diagnosing recurrence of pleural effusion and other complications that could be appropriately managed. Over time, our clinic has rapidly expanded its initial indications thus becoming the place to handle more complex respiratory patients in collaboration with, among others, thoracic surgeons and oncologists. In this article, we critically describe the strengths and pitfalls of our "pleural clinic" and propose an organizational model that results from a synergy between respiratory physicians and other professionals. This model can inspire other healthcare professionals to develop a similar organization based on their local setting.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Elisabetta Balestro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Dalla Pria HRF, Agrawal R, Shroff GS, Truong MT, Moran CA, Ahuja J. Case of the Season: Pleural Talcoma Mimicking Metastasis. Semin Roentgenol 2023; 58:387-390. [PMID: 37973267 DOI: 10.1053/j.ro.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Hanna R F Dalla Pria
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
| | - Rishi Agrawal
- Department of Radiology, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL
| | - Girish S Shroff
- Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cesar A Moran
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jitesh Ahuja
- Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kang J, Dennie C. Pleural Anatomy, Physiology, and Imaging Modalities - Relevant Concepts for the Radiologist. Semin Roentgenol 2023; 58:391-398. [PMID: 37973268 DOI: 10.1053/j.ro.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Jessie Kang
- Department of Diagnostic Radiology, Faulty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Carole Dennie
- Medical Imaging Department, The Ottawa Hospital, Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
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Lee GM, Walker CM. Pleural Thickening: Detection, Characterization, and Differential Diagnosis. Semin Roentgenol 2023; 58:399-410. [PMID: 37973269 DOI: 10.1053/j.ro.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Gregory M Lee
- Department of Radiology, Division of Cardiothoracic Imaging, University of Kansas Medical Center, Kansas City, KS
| | - Christopher M Walker
- Department of Radiology, Division of Cardiothoracic Imaging, University of Kansas Medical Center, Kansas City, KS.
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Jiang J, Lv FJ, Tao Y, Fu BJ, Li WJ, Lin RY, Chu ZG. Differentiation of pulmonary solid nodules attached to the pleura detected by thin-section CT. Insights Imaging 2023; 14:146. [PMID: 37697104 PMCID: PMC10495292 DOI: 10.1186/s13244-023-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Pulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs. RESULTS From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients' age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037-3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235-8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161-4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567-17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847-12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526-16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001). CONCLUSION In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant. CRITICAL RELEVANCE STATEMENT The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection. KEY POINTS • The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.
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Affiliation(s)
- Jin Jiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yang Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Lee J, Park J, Park JE, Lee YH, Choi SH, Seo H, Yoo SS, Lee SY, Cha SI, Park JY, Lim JK, Kim CH. Different characteristics of pleural abnormalities on computed tomography between tuberculous and malignant pleural effusions. Am J Med Sci 2023; 366:57-63. [PMID: 37105238 DOI: 10.1016/j.amjms.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 03/25/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Computed tomography (CT) is the mainstay imaging modality for suspected pleural malignancy. Tuberculous pleural effusion (TPE) can present with various pleural abnormalities. However, few studies have evaluated the different characteristics of pleural abnormalities on chest CT between TPE and malignant pleural effusion (MPE). METHODS Pleural abnormalities on contrast-enhanced CT in 277 and 289 patients with confirmed TPE and MPE diagnoses, respectively, were retrospectively assessed and compared between the two groups. Discriminating factors and diagnostic performance for MPE were evaluated using multivariate analysis and receiver operating characteristic curves. RESULTS Focal pleural thickening was present in 44 (16%) cases of TPEs and 202 (70%) of MPEs. Further characterization of focal pleural thickening showed that MPEs had a significantly greater number, larger maximal thickness, and more nodular contour form, compared to TPEs. On the other hand, diffuse and circumferential pleural thickening were significantly more common in TPEs. In multivariate analysis, independent predictors for MPE included focally thickened pleurae ≥7, maximum thickness ≥6 mm, nodular contour pattern, and the absence of diffuse pleural thickening. Out of all the individual or combined predictors for MPE, the presence of any one of the three sub-parameters of focal pleural thickening provided the best diagnostic yield with 66% sensitivity and 92% specificity. CONCLUSION Although focal pleural thickening in TPE mimics that in MPE, the features of MPE are significantly different from those of TPE in terms of size, number, and contour. These different characteristics may help differentiate MPE from TPE in patients with suspected MPE.
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Affiliation(s)
- Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ji Eun Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sun Ha Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Chang Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Szczyrek M, Bitkowska P, Jutrzenka M, Szudy-Szczyrek A, Drelich-Zbroja A, Milanowski J. Pleural Neoplasms-What Could MRI Change? Cancers (Basel) 2023; 15:3261. [PMID: 37370871 DOI: 10.3390/cancers15123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.
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Affiliation(s)
- Michał Szczyrek
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Paulina Bitkowska
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marta Jutrzenka
- Collegium Medicum, University of Warmia and Mazury in Olsztyn, Aleja Warszawska 30, 11-041 Olsztyn, Poland
| | - Aneta Szudy-Szczyrek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-090 Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Radiology and Neuroradiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
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Wang S, Tan X, Li P, Fan Q, Xia H, Tian S, Pan F, Zhan N, Yu R, Zhang L, Duan Y, Xu J, Ma Y, Chen W, Li Y, Zhao Z, Liu C, Bao Q, Yang L, Jin Y. Differentiation of malignant from benign pleural effusions based on artificial intelligence. Thorax 2023; 78:376-382. [PMID: 36180066 PMCID: PMC10086496 DOI: 10.1136/thorax-2021-218581] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This study aimed to construct artificial intelligence models based on thoracic CT images to perform segmentation and classification of benign pleural effusion (BPE) and malignant pleural effusion (MPE). METHODS A total of 918 patients with pleural effusion were initially included, with 607 randomly selected cases used as the training cohort and the other 311 as the internal testing cohort; another independent external testing cohort with 362 cases was used. We developed a pleural effusion segmentation model (M1) by combining 3D spatially weighted U-Net with 2D classical U-Net. Then, a classification model (M2) was built to identify BPE and MPE using a CT volume and its 3D pleural effusion mask as inputs. RESULTS The average Dice similarity coefficient, Jaccard coefficient, precision, sensitivity, Hausdorff distance 95% (HD95) and average surface distance indicators in M1 were 87.6±5.0%, 82.2±6.2%, 99.0±1.0%, 83.0±6.6%, 6.9±3.8 and 1.6±1.1, respectively, which were better than those of the 3D U-Net and 3D spatially weighted U-Net. Regarding M2, the area under the receiver operating characteristic curve, sensitivity and specificity obtained with volume concat masks as input were 0.842 (95% CI 0.801 to 0.878), 89.4% (95% CI 84.4% to 93.2%) and 65.1% (95% CI 57.3% to 72.3%) in the external testing cohort. These performance metrics were significantly improved compared with those for the other input patterns. CONCLUSIONS We applied a deep learning model to the segmentation of pleural effusions, and the model showed encouraging performance in the differential diagnosis of BPE and MPE.
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Affiliation(s)
- Sufei Wang
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Xueyun Tan
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Piqiang Li
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Chinese Academy of Sciences Wuhan Institute of Physics and Mathematics, Wuhan, Hubei, China
| | - Qianqian Fan
- Department of Radiology, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Hui Xia
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Shan Tian
- Department of Infectious Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Feng Pan
- Department of Radiology, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Na Zhan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Rong Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Liang Zhang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yanran Duan
- School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Juanjuan Xu
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Yanling Ma
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Wenjuan Chen
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Yan Li
- Department of Pathology, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Zilin Zhao
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Chaoyang Liu
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Chinese Academy of Sciences Wuhan Institute of Physics and Mathematics, Wuhan, Hubei, China
| | - Qingjia Bao
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Chinese Academy of Sciences Wuhan Institute of Physics and Mathematics, Wuhan, Hubei, China
| | - Lian Yang
- Department of Radiology, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Wuhan Union Hospital, Wuhan, Hubei, China
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13
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Chen Y, Li L, Wang C, Zhang Y, Zhou Y. Necrotizing Pneumonia in Children: Early Recognition and Management. J Clin Med 2023; 12:jcm12062256. [PMID: 36983257 PMCID: PMC10051935 DOI: 10.3390/jcm12062256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
Necrotizing pneumonia (NP) is an uncommon complicated pneumonia with an increasing incidence. Early recognition and timely management can bring excellent outcomes. The diagnosis of NP depends on chest computed tomography, which has radiation damage and may miss the optimal treatment time. The present review aimed to elaborate on the reported predictors for NP. The possible pathogenesis of Streptococcus pneumoniae, Staphylococcus aureus, Mycoplasma pneumoniae and coinfection, clinical manifestations and management were also discussed. Although there is still a long way for these predictors to be used in clinical, it is necessary to investigate early predictors for NP in children.
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Affiliation(s)
- Yuanyuan Chen
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Lanxin Li
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Chenlu Wang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yuanyuan Zhang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence: (Y.Z.); (Y.Z.)
| | - Yunlian Zhou
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence: (Y.Z.); (Y.Z.)
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14
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Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
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15
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Addala DN, Denniston P, Sundaralingam A, Rahman NM. Optimal diagnostic strategies for pleural diseases and identifying high-risk patients. Expert Rev Respir Med 2023; 17:15-26. [PMID: 36710423 DOI: 10.1080/17476348.2023.2174527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Pleural diseases encompass a broad range of conditions with diverse and heterogenous etiologies. Diagnostics in pleural diseases thus represents a challenging field with a wide array of available testing to distinguish between the numerous causes of pleural disease. Nonetheless, deploying best practice diagnostics in this area is essential in reducing both duration o the investigation pathway and symptom burden. AREAS COVERED This article critically appraises the optimal diagnostic strategies and pathway in patients with pleural disease, reviewing the latest evidence and key practice points in achieving a treatable diagnosis in patients with pleural disease. We also cover future and novel directions that are likely to influence pleural diagnostics in the near future. PubMed was searched for articles related to pleural diagnostics (search terms below), with the date ranges including June 2012 to June 2022. EXPERT OPINION No single test will ever be sufficient to provide a diagnosis in pleural conditions. The key to reducing procedure burden and duration to diagnosis lies in personalizing the investigation pathway to patients and deploying tests with the highest diagnostic yield early (such as pleural biopsy in infection and malignancy). Novel biomarkers may also allow earlier diagnostic precision in the near future.
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Affiliation(s)
- D N Addala
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, Oxford University, Oxford, UK.,Department of Respiratory Medicine, Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK
| | - P Denniston
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, Oxford University, Oxford, UK.,Department of Respiratory Medicine, Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK
| | - A Sundaralingam
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, Oxford University, Oxford, UK.,Department of Respiratory Medicine, Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK
| | - N M Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, Oxford University, Oxford, UK.,Department of Respiratory Medicine, Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK.,Oxford Biomedical Research Centre, National Institute for Health Research, Oxford, UK.,Chinese Academy of Medical Science Oxford Institute, Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, UK
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16
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Application of deep learning-based super-resolution to T1-weighted postcontrast gradient echo imaging of the chest. LA RADIOLOGIA MEDICA 2023; 128:184-190. [PMID: 36609662 PMCID: PMC9938811 DOI: 10.1007/s11547-022-01587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES A deep learning-based super-resolution for postcontrast volume-interpolated breath-hold examination (VIBE) of the chest was investigated in this study. Aim was to improve image quality, noise, artifacts and diagnostic confidence without change of acquisition parameters. MATERIALS AND METHODS Fifty patients who received VIBE postcontrast imaging of the chest at 1.5 T were included in this retrospective study. After acquisition of the standard VIBE (VIBES), a novel deep learning-based algorithm and a denoising algorithm were applied, resulting in enhanced images (VIBEDL). Two radiologists qualitatively evaluated both datasets independently, rating sharpness of soft tissue, vessels, bronchial structures, lymph nodes, artifacts, cardiac motion artifacts, noise levels and overall diagnostic confidence, using a Likert scale ranging from 1 to 4. In the presence of lung lesions, the largest lesion was rated regarding sharpness and diagnostic confidence using the same Likert scale as mentioned above. Additionally, the largest diameter of the lesion was measured. RESULTS The sharpness of soft tissue, vessels, bronchial structures and lymph nodes as well as the diagnostic confidence, the extent of artifacts, the extent of cardiac motion artifacts and noise levels were rated superior in VIBEDL (all P < 0.001). There was no significant difference in the diameter or the localization of the largest lung lesion in VIBEDL compared to VIBES. Lesion sharpness as well as detectability was rated significantly better by both readers with VIBEDL (both P < 0.001). CONCLUSION The application of a novel deep learning-based super-resolution approach in T1-weighted VIBE postcontrast imaging resulted in an improvement in image quality, noise levels and diagnostic confidence as well as in a shortened acquisition time.
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17
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Clinicopathological Features of Intrathoracic Liposarcoma-A Systematic Review with an Illustrative Case. J Clin Med 2022; 11:jcm11247353. [PMID: 36555969 PMCID: PMC9781777 DOI: 10.3390/jcm11247353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Liposarcoma (LPS) is one of the most common soft-tissue sarcomas. However, intrathoracic LPS is rare, as only 1% of all LPS cases are found in the thorax. METHODS A systematic literature review through PubMed and Embase databases was performed. Only eligible case reports and case series reporting intrathoracic LPS in adult patients were included. Kaplan-Meier curves were calculated to evaluate the survival rate of included patients based on the histological subtype of LPS. RESULTS 123 studies reporting 197 patients were included. We added a case of a 69-year-old female patient with recurrent giant intrathoracic LPS. The primary tumor measured 15.1cm × 22.9 cm × 21.9 cm and weighed 3100 g. Six months later, the patient was admitted to the hospital with another intrathoracic tumor measuring 9.5 cm × 9 cm× 1.4 cm. The immunohistochemical studies showed expression of murine double minute 2 (MDM2) antigen in both primary and recurrent tumor cells. CONCLUSIONS Dyspnea, chest pain, and cough were the most common symptoms reported in included studies. Overall, the 5-year survival rate was 62%. The highest survival was observed in well-differentiated LPS patients (80%) and the lowest in myxoid LPS (31%).
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18
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Désage AL, Mismetti V, Jacob M, Pointel S, Perquis MP, Morfin M, Guezara S, Langrand A, Galor C, Trouillon T, Diaz A, Karpathiou G, Froudarakis M. Place du pneumologue interventionnel dans la gestion des pleurésies métastatiques. Rev Mal Respir 2022; 39:778-790. [DOI: 10.1016/j.rmr.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
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19
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Kumari S, Jaseemudheen M. Assessment of Pleural Effusion by Means of Imaging Modalities. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1757446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPleural effusion is the fluid collection in the pleural cavity between the parietal and visceral pleura. It is caused by parenchymal diseases such as inflammatory disorders or infection. Pleural effusion can be diagnosed using imaging modalities such as X-ray, computed tomography (CT) scan, ultrasound, and magnetic resonance imaging (MRI).MRI is rarely performed to investigate pleural effusion due to motion artifacts and has a poor spatial resolution. Benign and malignant pleural effusion can be diagnosed using an X-ray, CT scan, or ultrasound. Pleural effusion volume can be measured by using ultrasound. This article reviews the feasibility of investigating pleural effusion and fluid drainage in medical imaging and compares to find the best modality for its diagnosis.
Description: This article reports the possible options to detect pleural effusion in medical imaging and compares them to find the best modality for its diagnosis.
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Affiliation(s)
- Swati Kumari
- Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, India
| | - M.M. Jaseemudheen
- Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, India
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20
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Bekele A, Alayande BT. Management of Empyema Thoracis in Low-Resource Settings. Thorac Surg Clin 2022; 32:361-372. [PMID: 35961744 DOI: 10.1016/j.thorsurg.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Most cases of empyema thoracis are sequelae of severe pneumonia, but chest trauma and complications of chest tube insertion as cause are not uncommon in low-resource settings. Diagnosis is usually delayed due to delayed presentation to health care facilities, low index of suspicion among health care professionals, and inability to properly stage the disease with the available diagnostic tools. Early use of antibiotics and appropriate-sized and well-placed chest tube drainage is associated with good outcomes at a decreased cost. Surgical management of empyema thoracis is indicated when chest tube drainage and antibiotic treatment fail to achieve complete resolution.
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Affiliation(s)
- Abebe Bekele
- University of Global Health Equity Kigali Heights, Plot 772, KG 7 Avenue, 5th floor, PO Box 6955, Kigali, Rwanda; Addis Ababa University, School of Medicine, Addis Ababa, Ethiopia.
| | - Barnabas Tobi Alayande
- University of Global Health Equity Kigali Heights, Plot 772, KG 7 Avenue, 5th floor, PO Box 6955, Kigali, Rwanda; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
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21
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Soni A, Guliani A, Nehra K, Mehta PK. Insight into diagnosis of pleural tuberculosis with special focus on nucleic acid amplification tests. Expert Rev Respir Med 2022; 16:887-906. [PMID: 35728039 DOI: 10.1080/17476348.2022.2093189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pleural tuberculosis (TB) is the archetype of extrapulmonary TB (EPTB), which mainly affects the pleural space and leads to exudative pleural effusion. Diagnosis of pleural TB is a difficult task predominantly due to atypical clinical presentations and sparse bacillary load in clinical specimens. AREA COVERED We reviewed the current literature on the globally existing conventional/latest modalities for diagnosing pleural TB. Bacteriological examination (smear/culture), tuberculin skin testing/interferon-γ release assays, biochemical testing, imaging and histopathological/cytological examination are the main modalities. Moreover, nucleic acid amplification tests (NAATs), i.e. loop-mediated isothermal amplification, PCR/multiplex-PCR, nested-PCR, real-time PCR and GeneXpert® MTB/RIF are being utilized. Currently, GeneXpert Ultra, Truenat MTBTM, detection of circulating Mycobacterium tuberculosis (Mtb) cell-free DNA by NAATs, aptamer-linked immobilized sorbent assay and immuno-PCR (I-PCR) have also been exploited. EXPERT OPINION Routine tests are not adequate for effective pleural TB diagnosis. The latest molecular/immunological tests as discussed above, and the other tools, i.e. real-time I-PCR/nanoparticle-based I-PCR and identification of Mtb biomarkers within urinary/serum extracellular vesicles being utilized for pulmonary TB and other EPTB types may also be exploited to diagnose pleural TB. Reliable diagnosis and early therapy would reduce the serious complications associated with pleural TB, i.e. TB empyema, pleural fibrosis, etc.
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Affiliation(s)
- Aishwarya Soni
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, India.,Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal, Sonipat-131039, India
| | - Astha Guliani
- Department of TB & Respiratory Medicine, Pt. BD Postgraduate Institute of Medical Sciences, Rohtak-124001, India
| | - Kiran Nehra
- Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal, Sonipat-131039, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, India
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22
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Baldes N, Bölükbas S. Entzündliche und infektiöse Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen. Zentralbl Chir 2022; 147:287-298. [DOI: 10.1055/a-1720-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEntzündliche Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen umfassen ein weites Spektrum von der komplizierten Pneumonie, der Tuberkulose, Mykosen bis hin zur Echinokokkose.
Die Häufigkeit hängt stark von der geografischen Herkunft ab. Diese Übersichtsarbeit gibt einen Überblick von der Diagnostik bis hin zur chirurgischen Therapie dieser Erkrankungen beim
pädiatrischen Kollektiv.
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Affiliation(s)
- Natalie Baldes
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
| | - Servet Bölükbas
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
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23
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PE MIMICS: a structured approach for the emergency radiologist in the evaluation of chest pain. Emerg Radiol 2022; 29:585-593. [DOI: 10.1007/s10140-022-02023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
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24
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Watanabe K, Takabe Y, Iizuka S, Otsuki Y, Nakamura T. Solitary fibrous tumor of the pleura mimicking a soft tissue sarcoma of the chest wall. Int J Surg Case Rep 2021; 91:106746. [PMID: 35026682 PMCID: PMC8760409 DOI: 10.1016/j.ijscr.2021.106746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction and importance Solitary fibrous tumors of the pleura (SFTPs) present a diagnostic challenge. We herein report a successful case mimicking a soft tissue sarcoma of the chest wall by a meticulous evaluation of the conventional images. Case presentation A 51-year-old woman presented with a left thoracic mass. The mass exhibited an extrapleural sign, which suggested a chest wall origin. However, the mass was found to be located more caudally by additional computed tomography. This positional change suggested that the mass was pedunculated from the visceral pleura, and an SFTP was suspected. The mass was found to originate from the visceral pleura of the left lower lobe and a pathological diagnosis of an SFTP was confirmed. Clinical discussion Although a positional shift with a postural change or the respiratory phase is a well-known characteristic radiological finding, such an intentional imaging study is available only for suspicious cases of SFTPs. Conclusions SFTPs pose a diagnostic challenge because of their rarity and the lack of specific radiological findings. Even conventional radiological images can be diagnostic by performing a meticulous evaluation regardless of any specific diagnosis being initially assumed. Solitary Fibrous Tumor of the Pleura (SFTP) poses a diagnostic challenge because of their rarity and the lack of specific radiological findings. The positional shift with a postural change or the respiratory phase is one of the most characteristic radiological findings, but would be feasible only in the suspicious cases of SFTP. Even conventional radiological images can be diagnostic by performing a meticulous evaluation regardless of any specific diagnosis being initially assumed.
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Affiliation(s)
- Kentaro Watanabe
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Yuya Takabe
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan
| | - Shuhei Iizuka
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
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25
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Sabri YY, Mahmoud IH, El-Gendy LT, Abd El-Mageed MR, Tadros SF. Added value of diffusion-weighted MRI in assessment of pleural lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00557-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions.
Results
Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001).
Conclusion
Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.
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Croft M, Lim W, Lavender N, Gormly K. Optimising CT-chest protocols and the added value of venous-phase contrast timing; Observational case-control. J Med Imaging Radiat Oncol 2021; 66:768-775. [PMID: 34799981 DOI: 10.1111/1754-9485.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To optimize CT chest protocol by comparing venous contrast timing with arterial timing for contrast opacification in vessels, qualitative image quality and radiologists' satisfaction and diagnostic confidence in assessing for potential nodal, pleural and pulmonary disease in general oncology outpatients. METHOD Matched case-control study performed following CT protocol update. 92 patients with a range of primary malignancies with 2 CT chests in a 2-year period, one with an arterial phase protocol and the second in the 60 second venous phase, were included. Contrast attenuation in aorta, pulmonary artery and liver were measured. Subjective measurements assessed perivenous artefact, confidence in nodal pleural and pulmonary assessment and presence of pulmonary emboli. Statistical analysis was performed using paired and unpaired t-tests. RESULTS Venous-phase CT demonstrated more consistent enhancement of the vessels, with higher attenuation of the nodes, pulmonary and pleural lesions. There was a significant reduction in perivenous beam hardening artefact on venous-phase CT (P < 0.001). Diagnostic confidence was significantly higher for nodal assessment and pleural abnormality visibility (P < 0.001) and pleural assessment (P < 0.05). There was no significant difference in pulmonary mass visibility. There was adequate enhancement to diagnose significant pulmonary emboli (PE) with 4 incidental PEs detected on the venous phase, extending to segmental vessels. CONCLUSION Venous-phase CT chest performs better than arterial-phase on all fronts, without compromising assessment of incidental pulmonary emboli. When intravenous contrast is indicated in a routine chest CT (excluding a CT-angiogram), the default timing should be a venous or 60s phase.
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Affiliation(s)
- Michael Croft
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - WanYin Lim
- Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Dr Jones and Partners, Eastwood, South Australia, Australia
| | - Nusha Lavender
- Dr Jones and Partners, Eastwood, South Australia, Australia
| | - Kirsten Gormly
- Dr Jones and Partners, Eastwood, South Australia, Australia.,The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
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27
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Diagnosis of tuberculous pleural effusions: A review. Respir Med 2021; 188:106607. [PMID: 34536698 DOI: 10.1016/j.rmed.2021.106607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 01/24/2023]
Abstract
Tuberculous pleural effusion (TPE) is the second most common presentation of extrapulmonary tuberculosis. The paucibacillary nature of the effusion poses diagnostic challenges. Biomarkers like adenosine deaminase and interferon-γ have some utility for diagnosing TPEs, as do cartridge-based polymerase chain reaction (PCR) methods. When these fluid studies remain indeterminate, pleural biopsies must be performed to confirm the diagnosis. This review article elaborates on the scientific evidence available for various diagnostic tests and presents a practical approach to the diagnosis of TPEs.
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Penha D, Pinto E, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. The impact of lung parenchyma attenuation on nodule volumetry in lung cancer screening. Insights Imaging 2021; 12:84. [PMID: 34170410 PMCID: PMC8233433 DOI: 10.1186/s13244-021-01027-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Recent recommendations for lung nodule management include volumetric analysis using tools that present intrinsic measurement variability, with possible impacts on clinical decisions and patient safety. This study was conducted to evaluate whether changes in the attenuation of the lung parenchyma adjacent to a nodule affect the performance of nodule segmentation using computed tomography (CT) studies and volumetric tools. Methods Two radiologists retrospectively applied two commercially available volumetric tools for the assessment of lung nodules with diameters of 5–8 mm detected by low-dose chest CT during a lung cancer screening program. The radiologists recorded the success and adequacy of nodule segmentation, nodule volume, manually and automatically (or semi-automatically) obtained long- and short-axis measurements, mean attenuation of adjacent lung parenchyma, and presence of interstitial lung abnormalities or disease, emphysema, pleural plaques, and linear atelectasis. Regression analysis was performed to identify predictors of good nodule segmentation using the volumetric tools. Interobserver and intersoftware agreement on good nodule segmentation was assessed using the intraclass correlation coefficient. Results In total, data on 1265 nodules (mean patient age, 68.3 ± 5.1 years; 70.2% male) were included in the study. In the regression model, attenuation of the adjacent lung parenchyma was highly significant (odds ratio 0.987, p < 0.001), with a large effect size. Interobserver and intersoftware agreement on good segmentation was good, although one software package performed better and measurements differed consistently between software packages. Conclusion For lung nodules with diameters of 5–8 mm, the likelihood of good segmentation declines with increasing attenuation of the adjacent parenchyma.
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Affiliation(s)
- Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal. .,Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
| | - Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio de Janeiro, RJ, Brazil.,Universidade Federal Fluminense Faculdade de Medicina, Niterói, RJ, Brazil
| | - Luís Taborda-Barata
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
| | - Klaus Irion
- Manchester University NHS Foundation Trust, Manchester, UK
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Simsek FS, Yuksel D, Yaylali O, Aslan HS, Kılıçarslan E, Bir F, Arslan M, Can FE, Ugurlu E. Can PET/CT be used more effectively in pleural effusion evaluation? Jpn J Radiol 2021; 39:1186-1194. [PMID: 34165683 DOI: 10.1007/s11604-021-01155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Sometimes, characterization of pleural effusion (PE) can be challenging especially in patients whom invasive procedures/recurrent invasive procedures cannot be performed. The main purpose of the study is to answer this question, Can 18F-FDG-PET/CT contribute to reduction in the number of invasive procedures or patients undergoing to invasive procedures? Results may increase the effectiveness of patient management by facilitating clinical decision-making, especially in patients who cannot undergo invasive/recurrent invasive procedures. METHODS Sixty-seven patients' 18F-FDG-PET/CT, pleural fluid cytologies (PFCs) and, if any, pleural biopsies were re-assessed. If patient's PFC/biopsy was malignant, effusion was considered as malignant. If two consecutive PFCs were negative in patients without biopsy, effusion was considered as benign. Characterization was based on consensus with baseline/follow-up 18F-FDG-PET/CT and clinical parameters in patients with one negative PFC (n = 6). RESULTS None of the 18F-FDG-PET/CT parameters could characterize PE alone. However, if PE maximum standardized uptake value (SUVmax) > 1.3 or PE SUVmax/mean standardized uptake value of mediastinal blood pool (MBP SUVmean) > 1.2 was combined with at least one of the following, specificity and positive predictive value (PPV) were 100%, accuracy was around 90%. Diffuse-nodular/nodular pleural thickness, post-obstructive atelectasis, nodule/mass with SUVmax > 2.5 in lung, multiple pulmonary nodules. All 29 patients who had SUVmax > 1.3 together with at least one of the mentioned four parameters diagnosed malignant pleural effusion (MPE). However, sensitivity and negative predictive value (NPV) were still insufficient. CONCLUSION Patients who have contraindications for invasive diagnostic methods, and meet the aforementioned criteria may be considered as MPE primarily. On the other hand, if PE SUVmax < 1.3 or PE SUVmax/MBP SUVmean < 1.2 with the negativity of the all four parameters mentioned above, it is difficult to say that this can be considered as benign pleural effusion (BPE) according to our results.
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Affiliation(s)
- Fikri Selcuk Simsek
- Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Dogangun Yuksel
- Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Olga Yaylali
- Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Halil Serdar Aslan
- Radiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Emel Kılıçarslan
- Pathology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ferda Bir
- Pathology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Muhammet Arslan
- Radiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Fatma Ezgi Can
- Biostatistics Department, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Erhan Ugurlu
- Pulmonology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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30
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Jiang W, Han Z, Tang X, Yin H, Zhang J. Diffusion-weighted imaging diagnostic algorithm in patients with suspected pleural malignancy. Eur Radiol 2021; 31:9038-9047. [PMID: 34047851 PMCID: PMC8589770 DOI: 10.1007/s00330-021-08013-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/12/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
Objectives The purpose of this study was to analyze the diagnostic performance and clinical application of diffusion-weighted imaging (DWI) in patients with suspected pleural malignancy (PM). Methods A retrospective review of patients with suspected PM was performed from March 2014 to August 2018 (NCT 02320617). All patients underwent chest DWI and computed tomography (CT) with cytological or histopathological findings as reference standards. The diagnostic performance of DWI and CT was analyzed and compared. A DWI diagnostic algorithm with three sequential steps was established. Results Seventy patients (61.6 ± 13.6 years; 47 males and 23 females) were included. The sensitivity of DWI (94.2%, 49/52) for the diagnosis of PM was significantly higher compared with CT (67.3%, 35/52), with similar specificity (72.2% vs. 72.2%, respectively). The apparent diffusion coefficient of malignant lesions (1.15 ± 0.32 × 10−3 mm2/s) was lower compared with benign lesions (1.46 ± 0.68 × 10−3 mm2/s), but the cutoff value was difficult to define for overlap between groups. Approximately 62.5% (5/8) of invasive procedures were avoided when using the DWI diagnostic algorithm in patients with suspected PM without N3 lymph node or extra-thoracic metastasis. Conclusion Including DWI into the diagnostic algorithm of suspected PM can effectively identify malignancy and avoid unnecessary invasive procedures, which may have some potential in clinical application. Key Points • Diffusion-weighted imaging can identify pleural malignancy much more efficiently than CT. • A diffusion-weighted imaging diagnostic algorithm helped to avoid unnecessary invasive procedures in patients without N3 lymph node or extra-thoracic lesions. • A hyperintense signal on DWI at a high b value (800 s/mm2) but not at a low b value (50 s/mm2) was a reliable signature of PM. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08013-6.
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Affiliation(s)
- Wenrui Jiang
- Department of Respiratory Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Zhiping Han
- Department of Respiratory Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Xing Tang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Jian Zhang
- Department of Respiratory Medicine, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
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31
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Esposito S, Dal Canto G, Caramia MR, Fainardi V, Pisi G, Principi N. Complications in community acquired pneumonia: magnitude of problem, risk factors, and management in pediatric age. Expert Rev Anti Infect Ther 2021; 20:45-51. [PMID: 33971782 DOI: 10.1080/14787210.2021.1927710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: In the last decades, the large use of several effective vaccines has dramatically reduced the incidence of community acquired pneumonia (CAP) in infants and children. Moreover, the availability of new antibiotics effective against emerging resistant strains of bacteria has greatly improved the early and long-term prognosis of this disease.Areas covered: The aim of this manuscript is to evaluate the burden of complicated CAP in pediatric age and to discuss its appropriate management.Expert opinion: Complicated CAP remains a problem for children in industrialized and developing countries. A larger use of lung ultrasonography (US) as first diagnostic approach could significantly improve early identification of cases at higher risk of complications. Difficult to solve, is the problem of the use of an antibiotic therapy able to assure adequate control in all the CAP cases, including those at high risk of or with already established complications. All these findings reveal that control of the incidence of complicated CAP remains difficult and will not be significantly changed in the next few years. Any attempt to improve complicated CAP management must be made. Consensus documents on better definition of the use of corticosteroids, fibrinolytic agents, and interventional procedures (including surgery) can allow us to reach this goal.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giulia Dal Canto
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Maria Rosaria Caramia
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Giovanna Pisi
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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"Multimodality imaging of the extrapleural space lesions". Clin Imaging 2021; 79:64-84. [PMID: 33892397 DOI: 10.1016/j.clinimag.2021.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022]
Abstract
Extrapleural space (EPS) is a potential space between the outer layer of the parietal pleura and the inner layer of the chest wall and the diaphragm. Many different pathologies including chronic inflammatory conditions, infections, trauma, neoplastic disease (both benign and malignant) as well as many infiltrative disorders can involve the EPS. It is one of the frequently overlooked entity on imaging due to relative lack of understanding of the anatomy and the imaging appearances of the diseases localized to this space. The knowledge of the EPS is essential for the radiologists as the pathologies which involve the EPS may require different treatment approach compared to pleural or parenchymal lung disease. Additionally, the EPS involvement may influence the staging and treatment planning for chest malignancies. In this review, we give an overview of the anatomy and various pathologies involving EPS, utility of different imaging modalities in the evaluation of EPS lesions with emphasis on cross sectional imaging and emerging technologies like spectral CT and its role in recognizing the imaging features which enable specific diagnosis of various pathologies.
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33
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Laursen CB, Clive A, Hallifax R, Pietersen PI, Asciak R, Davidsen JR, Bhatnagar R, Bedawi EO, Jacobsen N, Coleman C, Edey A, Via G, Volpicelli G, Massard G, Raimondi F, Evison M, Konge L, Annema J, Rahman NM, Maskell N. European Respiratory Society statement on thoracic ultrasound. Eur Respir J 2021; 57:13993003.01519-2020. [PMID: 33033148 DOI: 10.1183/13993003.01519-2020] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
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Affiliation(s)
- Christian B Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amelia Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jesper Rømhild Davidsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Niels Jacobsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | | | - Anthony Edey
- Dept of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg, Grand-Duchy of Luxembourg
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Dept of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Matthew Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Centre for HR, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Joint last authors
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Joint last authors
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34
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Gerloni R, Artusi N, Sisto UG, Tollot S, Copetti R. A serious fit of cough: A 66-year-old patient with myasthenia gravis presenting with spontaneous intercostal lung herniation after coughing. Case report and pathophysiological discussion. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.8911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a case of a 66-year-old man with history of myasthenia gravis, severe obesity and osteopenia self-presented to our Emergency Department (ED) with severe pain in his left hemithorax, occurred after an episode of cough three days before. No history of trauma was reported. The patient underwent a chest-XR showing uncomplicated spontaneous fractures of the 5th and 6th left ribs. He was therefore discharged with appropriate analgesic treatment. Five days later, the patient came back to our ED for a wide left abdominal hematoma, though hemodynamically stable and eupneic. A CT-scan with contrast showed a rare and unexpected spontaneous left intercostal lung herniation complicated with a diffuse subcutaneous emphysema, pneumothorax, loculated bilateral pleural effusion and abdominal hematoma. The patient was admitted, treated conservatively and safely discharged after two weeks. We also provide a pathophysiological discussion of the case and a literature review.
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35
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Delgado D, Ramírez O, Sultan N, Miranda P, Delgado A. Pleural plaques by inhalation of asbestos fibers. Rev Bras Med Trab 2020; 18:241-245. [PMID: 33324467 PMCID: PMC7732047 DOI: 10.47626/1679-4435-2020-493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Asbestos fiber pleural plaque is characterized by lesions composed of fibrous tissue that are located in the parietal pleura. They usually appear in up to 3 to 58% of workers who were exposed to asbestos fiber, and 0.5 to 8% in the general population. The objective of this article is to present a case report of a patient whose chest x-ray showed pleural changes associated with exposure to asbestos fibers. Case report A 49-year-old male patient, construction worker with a history of exposure to asbestos fibers, underwent a chest x-ray performed according to International Labor Organization (ILO) standards, which revealed focal pleural changes. Subsequently, the presence of pleural plaques was confirmed by computed tomography (CT) scan of the chest. Discussion Chest x-ray with ILO technique is the basic instrument for the identification of diseases related to asbestos fiber exposure. The study should be completed with a CT scan of the chest, whose sensitivity is greater, allowing early detection of pleural abnormalities. It is essential to obtain a detailed occupational history, since it is the most reliable and practical method to measure asbestos fiber exposure.
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Affiliation(s)
- Diemen Delgado
- Universidad de Guadalajara, Instituto de Seguridad y Salud en el Trabajo - Guadalajara (JAL), México
| | - Oscar Ramírez
- Universidad Científica del Sur, Escuela de Postgrado de Medicina Ocupacional y Medio Ambiente - Lima (LIM) Peru
| | - Nayab Sultan
- University of Birmingham, School of Geography, Earth and Environmental Sciences - Birmingham (BI), United Kingdom
| | - Patricio Miranda
- Instituto de Salud Pública de Chile, Departamento de Salud Ocupacional - Santiago (SCL), Chile
| | - Ashley Delgado
- Universidad Andrés Bello, Escuela de Medicina - Viña del Mar (VAL), Chile
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Kiser KJ, Ahmed S, Stieb S, Mohamed ASR, Elhalawani H, Park PYS, Doyle NS, Wang BJ, Barman A, Li Z, Zheng WJ, Fuller CD, Giancardo L. PleThora: Pleural effusion and thoracic cavity segmentations in diseased lungs for benchmarking chest CT processing pipelines. Med Phys 2020; 47:5941-5952. [PMID: 32749075 PMCID: PMC7722027 DOI: 10.1002/mp.14424] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022] Open
Abstract
This manuscript describes a dataset of thoracic cavity segmentations and discrete pleural effusion segmentations we have annotated on 402 computed tomography (CT) scans acquired from patients with non-small cell lung cancer. The segmentation of these anatomic regions precedes fundamental tasks in image analysis pipelines such as lung structure segmentation, lesion detection, and radiomics feature extraction. Bilateral thoracic cavity volumes and pleural effusion volumes were manually segmented on CT scans acquired from The Cancer Imaging Archive "NSCLC Radiomics" data collection. Four hundred and two thoracic segmentations were first generated automatically by a U-Net based algorithm trained on chest CTs without cancer, manually corrected by a medical student to include the complete thoracic cavity (normal, pathologic, and atelectatic lung parenchyma, lung hilum, pleural effusion, fibrosis, nodules, tumor, and other anatomic anomalies), and revised by a radiation oncologist or a radiologist. Seventy-eight pleural effusions were manually segmented by a medical student and revised by a radiologist or radiation oncologist. Interobserver agreement between the radiation oncologist and radiologist corrections was acceptable. All expert-vetted segmentations are publicly available in NIfTI format through The Cancer Imaging Archive at https://doi.org/10.7937/tcia.2020.6c7y-gq39. Tabular data detailing clinical and technical metadata linked to segmentation cases are also available. Thoracic cavity segmentations will be valuable for developing image analysis pipelines on pathologic lungs - where current automated algorithms struggle most. In conjunction with gross tumor volume segmentations already available from "NSCLC Radiomics," pleural effusion segmentations may be valuable for investigating radiomics profile differences between effusion and primary tumor or training algorithms to discriminate between them.
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Affiliation(s)
- Kendall J. Kiser
- John P. and Kathrine G. McGovern Medical SchoolHoustonTXUSA
- Center for Precision HealthUTHealth School of Biomedical InformaticsHoustonTXUSA
- Department of Radiation OncologyUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Sara Ahmed
- Department of Radiation OncologyUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Sonja Stieb
- Department of Radiation OncologyUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Abdallah S. R. Mohamed
- Department of Radiation OncologyUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
- MD Anderson Cancer Center‐UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
| | - Hesham Elhalawani
- Department of Radiation OncologyCleveland Clinic Taussig Cancer CenterClevelandOHUSA
| | - Peter Y. S. Park
- Department of Diagnostic and Interventional ImagingJohn P. and Kathrine G. McGovern Medical SchoolHoustonTXUSA
| | - Nathan S. Doyle
- Department of Diagnostic and Interventional ImagingJohn P. and Kathrine G. McGovern Medical SchoolHoustonTXUSA
| | - Brandon J. Wang
- Department of Diagnostic and Interventional ImagingJohn P. and Kathrine G. McGovern Medical SchoolHoustonTXUSA
| | - Arko Barman
- Center for Precision HealthUTHealth School of Biomedical InformaticsHoustonTXUSA
| | - Zhao Li
- Center for Precision HealthUTHealth School of Biomedical InformaticsHoustonTXUSA
| | - W. Jim Zheng
- Center for Precision HealthUTHealth School of Biomedical InformaticsHoustonTXUSA
| | - Clifton D. Fuller
- Department of Radiation OncologyUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
- MD Anderson Cancer Center‐UTHealth Graduate School of Biomedical SciencesHoustonTXUSA
| | - Luca Giancardo
- Center for Precision HealthUTHealth School of Biomedical InformaticsHoustonTXUSA
- Department of Radiation OncologyCleveland Clinic Taussig Cancer CenterClevelandOHUSA
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Guenther TM, Gustafson JD, Pribyl SM, Wozniak CJ. Recurrent Spontaneous Pneumothorax in a 47-Year-Old Woman. Mil Med 2020; 185:e1833-e1835. [PMID: 32687200 DOI: 10.1093/milmed/usz468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/15/2019] [Accepted: 12/13/2019] [Indexed: 11/12/2022] Open
Abstract
Pneumothorax is a condition where air exists in the chest cavity, outside the lung. The causes of pneumothorax are numerous and determining the etiology can aid in treatment and prevent recurrence. We describe a 47-year-old female patient with past medical history of endometriosis who presented to the emergency room with recurrent right sided pneumothorax, its onset correlating with onset of menses. She underwent video assisted thorascopic surgery for a suspected catamenial pneumothorax whereby nodular "chocolate" appearing areas were noted on the middle lobe and multiple similar appearing lesions and fenestrations were noted on the diaphragm. A biologic mesh was affixed to the diaphragm after which mechanical and chemical pleurodesis were performed. She tolerated the procedure well and has been symptom free since. Herein, we review the pathophysiology, diagnosis, and treatment strategies for catamenial pneumothorax in the hopes of increasing awareness and understanding of this rare cause of spontaneous pneumothorax.
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Affiliation(s)
- Timothy M Guenther
- Department of Surgery, University of California Davis, 2315 Stockton Blvd, Sacramento, CA 95817.,Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
| | - Joshua D Gustafson
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533.,Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Shea M Pribyl
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533
| | - Curtis J Wozniak
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, Fairfield, CA 94533.,Department of Cardiothoracic Surgery, University of California San Francisco, 500 Parnassus Ave #W420, San Francisco, CA 94143
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38
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de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet 2020; 396:786-798. [PMID: 32919518 DOI: 10.1016/s0140-6736(20)31550-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
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Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
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39
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Quek JC, Tan QL, Allen JC, Anantham D. Malignant pleural effusion survival prognostication in an Asian population. Respirology 2020; 25:1283-1291. [PMID: 32390227 DOI: 10.1111/resp.13837] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/10/2020] [Accepted: 04/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE LENT and PROMISE scores prognosticate survival in patients with MPE. Prognostication guides the selection of interventions and management. However, the predictive value of these scores and their refinements (modified-LENT) in Asians remain unclear. We aim to evaluate the performance of LENT, modified-LENT and clinical PROMISE scores; identify predictors of survival; and develop an alternative prognostication tool should current scores lack accuracy. METHODS Retrospective medical record review of an Asian pleuroscopy database from 2011 to 2018 of patients with MPE was conducted. The prognostic capability of current available scores were evaluated using C-statistics. Demographic and clinical variables as predictors of survival were assessed, and an alternative model was developed using logistic regression. RESULTS In 130 patients, the C-statistics for modified-LENT was not significantly different from LENT (0.59 (95% CI: 0.52-0.67) vs 0.56 (95% CI: 0.49-0.63); P = 0.403). In 57 patients, the PROMISE C-statistics was 0.72 (95% CI: 0.53-0.91). In our alternative prognostication model (n = 147), Sex, Eastern Cooperative Oncology Group status, Leukocyte count, EGFR mutation, Chemotherapy and primary Tumour type (SELECT) were predictors of 90-day mortality (C-statistic = 0.87 (95% CI: 0.79-0.95)). SELECT sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios using a predicted probability of 90-day mortality cut-off point of 10% were 0.91, 0.68, 0.34, 0.98, 2.83 and 0.13, respectively. CONCLUSION The LENT, modified-LENT and PROMISE scores have poor accuracy of survival prognostication in Asian patients with MPE undergoing pleuroscopy. The proposed SELECT prognostication model is accurate at identifying patients with high probability of survival at 90 days.
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Affiliation(s)
- Jonathan Caleb Quek
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Duke-National University of Singapore Medical School, Singapore
| | - Qiao Li Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - John Carson Allen
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Duke-National University of Singapore Medical School, Singapore
| | - Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Duke-National University of Singapore Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Hassan M, Mercer RM, Rahman NM. Thoracic ultrasound in the modern management of pleural disease. Eur Respir Rev 2020; 29:29/156/190136. [PMID: 32350086 DOI: 10.1183/16000617.0136-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/22/2019] [Indexed: 12/11/2022] Open
Abstract
Physician-led thoracic ultrasound (TUS) has substantially changed how respiratory disorders, and in particular pleural diseases, are managed. The use of TUS as a point-of-care test enables the respiratory physician to quickly and accurately diagnose pleural pathology and ensure safe access to the pleural space during thoracentesis or chest drain insertion. Competence in performing TUS is now an obligatory part of respiratory speciality training programmes in different parts of the world. Pleural physicians with higher levels of competence routinely use TUS during the planning and execution of more sophisticated diagnostic and therapeutic interventions, such as core needle pleural biopsies, image-guided drain insertion and medical thoracoscopy. Current research is gauging the potential of TUS in predicting the outcome of different pleural interventions and how it can aid in tailoring the optimum treatment according to different TUS-based parameters.
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Affiliation(s)
- Maged Hassan
- Chest Diseases Dept, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rachel M Mercer
- Oxford Pleural Unit, Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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41
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Uncommon thoracic manifestations from extrapulmonary tumors: Computed tomography evaluation - Pictorial review. Respir Med 2020; 168:105986. [PMID: 32469707 DOI: 10.1016/j.rmed.2020.105986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 11/23/2022]
Abstract
Although metastasis can occur at a variety of sites, pulmonary involvement is common in patients with cancer. Depending on the source and type of tumor, pulmonary metastases present with a wide range of radiologic appearances. Hematogenous dissemination through the pulmonary arteries to the pulmonary capillary network is the most common form of spread in pulmonary metastases. However, they may also reach the lung via lymphatic dissemination, secondary airway involvement, vessel tumor embolism, and direct chest invasion. In the evaluation of patients with known extrathoracic tumors, CT is the state-of-the-art imaging modality for detecting and characterize pulmonary metastases as well as to predict resectability. Although CT limitations are well known, knowledge of growth rates of various tumors and understanding the pattern of spread may be helpful clues in suggesting and even establish the specific diagnosis. The purpose of this pictorial review is to discuss the imaging appearances of different patterns of intrathoracic tumoral dissemination.
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42
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Park JE, Do YW, Lee DH, Lee SY, Lim JK, Choi SH, Seo HW, Yoo SS, Lee SY, Cha SI, Park JY, Lee J, Kim CH. Idiopathic Pleural Effusions: Characteristics and Discrimination From Cytology-Negative Malignant Pleural Effusions. Am J Med Sci 2020; 360:236-242. [PMID: 32423747 DOI: 10.1016/j.amjms.2020.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/10/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The etiology of pleural effusions often remained unknown notwithstanding surgical pleural biopsy and further clinical observation. A better understanding of clinical characteristics of patients with idiopathic pleural effusion (IPE) may improve the ability to differentiate between IPEs and cytology-negative malignant pleural effusions (MPEs) and facilitate the identification of patients requiring invasive investigation. However, little is known about the clinical factors that can help distinguish patients with IPE from those with cytology-negative MPE. MATERIALS AND METHODS Patients who were diagnosed with IPE or cytology-negative MPE between 2010 and 2017 were enrolled in this retrospective study. Clinical, laboratory and radiologic characteristics were compared between patients with IPE and cytology-negative MPE. Diagnostic performances of predictors for IPE were assessed using receiver operating characteristic curves. RESULTS Of 146 patients undergoing pleural biopsy owing to cytology-negative pleural effusion of uncertain cause, MPE was confirmed in 54 patients. IPE was ultimately diagnosed in 22 patients. Multivariate analysis demonstrated that a minimal amount of pleural effusion (odds ratio [OR] = 12.41, P = 0.039), presence of pleural nodularity (OR = 0.01, P < 0.001) and pleural fluid carcinoembryonic antigen levels less than 14 ng/mL (OR = 87.59, P = 0.002) were independent factors for distinguishing IPEs from cytology-negative MPEs. A combination of the absence of pleural nodularity with pleural fluid carcinoembryonic antigen levels less than 14 ng/mL yielded an area under the curve of 0.94 (sensitivity = 91% and specificity = 96%). CONCLUSIONS Using these readily available parameters to identify IPE in patients with cytology-negative exudative effusion of unknown cause can help guide decision-making when choosing to perform an invasive pleural biopsy or to take a conservative approach.
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Affiliation(s)
- Ji Eun Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Kwang Lim
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Sun Ha Choi
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Hye Won Seo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Shin Yup Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Yong Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
| | - Chang Ho Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
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Abstract
Malignant pleural effusion frequently complicates both solid and hematologic malignancies and is associated with high morbidity, mortality, and health care costs. Although no pleura-specific therapy is known to impact survival, both pleurodesis and indwelling pleural catheter (IPC) placement can significantly alleviate symptoms and improve quality of life. The optimal choice of therapy in terms of efficacy and particularly cost-effectiveness depends on patient preferences and individual characteristics, including lung expansion and life expectancy. Attempting chemical pleurodesis through an IPC in the outpatient setting appears to be a particularly promising approach in the absence of a nonexpandable lung.
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Affiliation(s)
- Majid Shafiq
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Suite 7-125, Baltimore, MD 21287, USA.
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Yan Q, Yang S, Shen J, Lu S, Shan F, Shi Y. 3T magnetic resonance for evaluation of adult pulmonary tuberculosis. Int J Infect Dis 2020; 93:287-294. [PMID: 32062060 DOI: 10.1016/j.ijid.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/17/2020] [Accepted: 02/09/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate image quality and detection rate of four 3T magnetic resonance imaging (MRI) sequences and MRI performances in pulmonary tuberculosis (TB) when compared to computed tomography (CT). METHODS Forty patients with pulmonary tuberculosis separately underwent CT and 3T-MRI with T1-weighted free-breathing star-volumetric interpolated breath-hold examination (Star-VIBE) and standard VIBE, T2-weighted two-dimensional fast BLADE turbo spin-echo (2D-fBLADE TSE) and three-dimensional isotropic turbo spin-echo (3D-SPACE). Four MRI sequences were compared in terms of detection rate and image quality, which consisted of signal to noise ratio (SNR), contrast to noise ratio (CNR) and 5-point scoring scale. The total sensitivity was also compared between CT and MRI. Inter-observer agreement on 5-point scoring scale was calculated by Cohen's kappa (k). SNR, CNR and 5-point scoring scale were compared using two-tailed pared t-test. Using CT as a reference, the MRI detection rate of pulmonary abnormality was evaluated by Pearson's Chi-square test. Furthermore, the sizes of the nodules (≥5 mm) were compared using intraclass correlation coefficient. RESULTS In this study, Free-breathing Star-VIBE had significantly better SNR and identical CNR compared with standard VIBE. 2D-fBLADE TSE had statistically higher SNR but uniform or inferior CNR compared with 3D-SPACE. Inter-observers showed excellent agreement on 5-point scoring scale. The average score of Star-VIBE and VIBE had no difference. The average score of 2D-fBLADE TSE was higher than 3D-SPACE. There were no statistical differences in the detection rates of non-calcified parenchymal lesions between Star-VIBE and standard VIBE, 2D-fBALDE TSE and 3D-SPACE. MRI is comparable to CT in detecting consolidation, cavity, non-calcified nodules of ≥5 mm and tree-in-bud signs compared to CT. MRI detected non-calcified nodules of <5 mm, 5-10 mm, ≥10 mm and calcified nodules with sensitivity of 69.6%, 90.6%, 100% and 89.5% respectively. In addition, the sizes of the nodules (≥5 mm) had statistical consistency. MRI is more sensitive in detecting caseous necrosis, liquefaction, active cavity, abnormalities of lymph nodes and pleura. CONCLUSIONS T1-weighted free-breathing Star-VIBE and T2-weighted 2D-fBLADE TSE, both with satisfactory image quality, are suitable for patients with pulmonary TB who need long-term follow-ups in clinical routine, especially for children, young women and pregnant women.
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Affiliation(s)
- Qinqin Yan
- Shanghai Institute of Medical Imaging, Shanghai, Fudan university, Shanghai, China; Department of Radiology, Shanghai public health clinical center, Shanghai, China
| | - Shuyi Yang
- Department of Radiology, Shanghai public health clinical center, Shanghai, China
| | - Jie Shen
- Department of Radiology, Shanghai public health clinical center, Shanghai, China
| | - Shuihua Lu
- Department of Tuberculosis, Shanghai public health clinical center, Shanghai, China
| | - Fei Shan
- Department of Radiology, Shanghai public health clinical center, Shanghai, China.
| | - Yuxin Shi
- Department of Radiology, Shanghai public health clinical center, Shanghai, China.
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45
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Thiam K, Guinde J, Laroumagne S, Bourinet V, Berbis J, Touré NO, Dutau H, Astoul P. Lateral decubitus chest radiography or chest ultrasound to predict pleural adhesions before medical thoracoscopy: a prospective study. J Thorac Dis 2019; 11:4292-4297. [PMID: 31737314 DOI: 10.21037/jtd.2019.09.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medical thoracoscopy (MT) is the gold-standard to investigate unexplained pleural exudates. However, the major prerequisite is an easy pleural access obtained by creating an artificial pneumothorax at the beginning of the procedure which can be a challenge in case of pleural adhesions and make the procedure unsafe. The detection of pleural adhesions prior to MT is necessary. Nowadays chest ultrasonography (CUS) is considered the best procedure to detect pleural adhesions. However, this technique is not available in all countries where the assessment of the pleural cavity is only based on chest radiography. Therefore, we conducted this study to compare the performance of lateral decubitus chest radiography (LDCR) and CUS to predict pleural adhesions. METHODS LDCR and CUS were performed prior MT in consecutive patients presenting exudative pleural effusion to detect pleural adhesions. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each pre thoracoscopy procedure were calculated. RESULTS Data analysis for the sixty-six enrolled patients showed a higher superiority to detect pleural adhesions for CUS in comparison to LDCR for all the parameters analyzed. CONCLUSIONS These results confirm that pre-MT CUS is the cornerstone to evaluate the access to the pleural cavity and justify educational program in this field in all centers which intends to develop interventional pulmonology.
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Affiliation(s)
- Khady Thiam
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,Department of Pulmonology and Phtisiology, NUHC Fann, Dakar, Senegal
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France
| | - Valerian Bourinet
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Julie Berbis
- EA 3279, Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France
| | | | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France.,School of Medicine, Aix-Marseille University, Marseille, France
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Ferreiro L, Toubes ME, San José ME, Suárez-Antelo J, Golpe A, Valdés L. Advances in pleural effusion diagnostics. Expert Rev Respir Med 2019; 14:51-66. [PMID: 31640432 DOI: 10.1080/17476348.2020.1684266] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Pleural effusion is a common clinical problem. Yet, in a significant proportion of patients (~20%), the cause of pleural effusion remains unknown. Understanding the diagnostic value of pleural fluid tests is crucial for the development of accurate diagnostic models.Areas covered: This paper provides an overview of latest advances in the diagnosis of pleural effusion based on the best evidence available.Expert opinion: For pleural fluid tests to have a good diagnostic value, it is necessary that data obtained from clinical history, physical examination, and radiological studies are correctly interpreted. Thoracentesis and pleural biopsy should always be performed under image guidance to improve its diagnostic sensitivity and prevent complications. Nucleic acid amplification tests, pleural tissue cultures, and collection of pleural fluid in blood culture bottles improve the diagnostic yield of pleural fluid cultures. Although undiagnosed pleural effusions generally have a favorable prognosis, follow-up is recommended to prevent the development of a malignant pleural effusion.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María E Toubes
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - María E San José
- Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Department of Clinical Analysis, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Group of Research in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Fonseca EKUN, Shoji H, Tachibana A, Funari MBG, Szarf G. The interface sign. Abdom Radiol (NY) 2019; 44:372-373. [PMID: 29946926 DOI: 10.1007/s00261-018-1680-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Hamilton Shoji
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
| | - Adriano Tachibana
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
| | | | - Gilberto Szarf
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil.
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48
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Abstract
Imaging in intensive care unit (ICU) is integral to patient management. The portable chest radiograph is the most commonly requested imaging examination in ICU, and, despite its limitations, it significantly contributes to the decision-making process. Multidetector CT (MDCT) is reserved for relatively complex and challenging clinical scenarios. Bedside ultrasound is emerging as a promising imaging modality as it does not subject the patients to risks and resources involved in the transportation of these patients to the CT facility. Ultrasound is an effective modality to triage patients and is being increasingly incorporated into the emergency and intensive care management algorithms.
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Affiliation(s)
- Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore
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49
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Lo Russo G, Tessari A, Capece M, Galli G, de Braud F, Garassino MC, Palmieri D. MicroRNAs for the Diagnosis and Management of Malignant Pleural Mesothelioma: A Literature Review. Front Oncol 2018; 8:650. [PMID: 30622932 PMCID: PMC6308141 DOI: 10.3389/fonc.2018.00650] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor with a variable incidence among different countries. Occupational asbestos exposure is the most important etiological factor and a very long latency period is widely reported. In the early phase of the disease, clinical signs are absent or not specific. For this reason, the diagnosis is frequently achieved only in the advanced stages. The histopathological diagnosis per se is also very complex, and no known factor can predict the prognosis with certainty. Nonetheless, current survival rates remain very low, despite the use of standard treatments, which include surgery, chemotherapy and radiotherapy. The identification of new prognostic and/or diagnostic biomarkers, and the discovery of therapeutic targets is a priority and could lead to a real significant impact on the management of malignant pleural mesothelioma. In this scenario, the role of microRNAs is becoming increasingly relevant, with the promise of a quick translation in the current clinical practice. Despite the relative novelty of this field, the number of works and candidate microRNAs that are present in literature is striking. Unfortunately, to date the microRNAs with the most clinical relevance for MPM are still matter of debate, probably due to the variety of approaches, techniques, and collected samples. Although specific microRNAs (e.g., let-7, miR-15 and miR-16, miR-21, miR-34a, and the miR-200 family) have been reported several times from different groups, the heterogeneity of published data reinforces the need of more comprehensive and unified studies on this topic. In this review we collect and discuss the studies focused on the involvement of microRNAs in different aspects of MPM, from their biological role in tumorigenesis and progression, to their possible application as diagnostic, prognostic and predictive biomarkers. Lastly, we examine their potential value as for the design of therapeutic approaches that could benefit MPM patients.
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Affiliation(s)
- Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Tessari
- Department of Cancer Biology and Genetics, the Ohio State University, Columbus, OH, United States
| | - Marina Capece
- Department of Cancer Biology and Genetics, the Ohio State University, Columbus, OH, United States
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Palmieri
- Department of Cancer Biology and Genetics, the Ohio State University, Columbus, OH, United States
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Marchetti G, Arondi S, Baglivo F, Lonni S, Quadri F, Valsecchi A, Venturoli N, Ceruti P. New insights in the use of pleural ultrasonography for diagnosis and treatment of pleural disease. CLINICAL RESPIRATORY JOURNAL 2018; 12:1993-2005. [PMID: 29679518 DOI: 10.1111/crj.12907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 03/21/2018] [Indexed: 12/15/2022]
Abstract
The use of transthoracic ultrasound (US) has acquired a wide consensus among respiratory physicians during the last few years. The development of portable devices promotes patient's bedside evaluation providing rapid, real-time and low-cost diagnostic information. The different acoustic impedance between different tissues and organs produces artifacts known as A lines, B lines, sliding sign, lung point, etc. The identification of such artifacts is essential to discriminate normal pleural appearance from the presence of pleural effusion, pneumothorax, thickenings and tumors. Ultrasounds are also a valuable tool during interventional procedures, such as thoracentesis, chest tube insertion and transcutaneous biopsy. Its use is recommended before medical thoracoscopy in order to assess the best site of trocar insertion according to presence, quantity and characteristics of pleural effusion. The aim of this review is to provide practical tips on chest ultrasound in clinical and interventional respiratory practice.
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Affiliation(s)
| | - Sabrina Arondi
- Division of Pulmonology, Carlo Poma Hospital, Mantova, Italy
| | - Francesca Baglivo
- Specialization School in Respiratory Diseases, University of Brescia, Brescia, Italy
| | - Sara Lonni
- Specialization School in Respiratory Diseases, University of Brescia, Brescia, Italy
| | - Federico Quadri
- Division of Pulmonology, Spedali Civili Hospital, Brescia, Italy
| | | | - Nicola Venturoli
- Specialization School in Respiratory Diseases, University of Brescia, Brescia, Italy
| | - Paolo Ceruti
- Division of Pulmonology, Spedali Civili Hospital, Brescia, Italy
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