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McNally E, Ross C, Gleeson LE. The tuberculous pleural effusion. Breathe (Sheff) 2023; 19:230143. [PMID: 38125799 PMCID: PMC10729824 DOI: 10.1183/20734735.0143-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progression to pulmonary TB is high. Diagnosis is challenging, as pleural TB is paucibacillary in most cases, but every effort should be made to obtain microbiological diagnosis, especially where drug resistance is suspected. Much attention has been focussed on adjunctive investigations to support diagnosis, but clinicians must be aware that apparent diagnostic accuracy is affected both by the underlying TB prevalence in the population, and by the diagnostic standard against which the specified investigation is being evaluated. Pharmacological treatment of pleural TB is similar to that of pulmonary TB, but penetration of the pleural space may be suboptimal in complicated effusions. Evidence for routine drainage is limited, but evacuation of the pleural space is indicated in complicated disease. Educational aims To demonstrate that pleural TB incorporates a wide spectrum of disease, ranging from self-resolving lymphocytic effusions to severe TB empyema with serious sequelae.To emphasise the high coexistence of pulmonary TB with pleural TB, and the importance of obtaining sputum for culture (induced if necessary) in all cases.To explore the significant diagnostic challenges posed by pleural TB, and consequently the frequent lack of information about drug sensitivity prior to initiating treatment.To highlight the influence of underlying TB prevalence in the population on the diagnostic accuracy of adjunctive investigations for the diagnosis of pleural TB.To discuss concerns around penetration of anti-TB medications into the pleural space and how this can influence decisions around treatment duration in practice.
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Affiliation(s)
- Emma McNally
- Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland
| | - Clare Ross
- Department of Respiratory Medicine, Imperial NHS Healthcare Trust, London, UK
| | - Laura E. Gleeson
- Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin School of Medicine, St James's Hospital, Dublin, Ireland
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2
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Shaw JA, Louw EH, Koegelenberg CF. A practical approach to the diagnosis and management of malignant pleural effusions in resource-constrained settings. Breathe (Sheff) 2023; 19:230140. [PMID: 38125800 PMCID: PMC10729815 DOI: 10.1183/20734735.0140-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/03/2023] [Indexed: 12/23/2023] Open
Abstract
No pleural intervention in a patient with confirmed malignant pleural effusion (MPE) prolongs life, but even the recommended interventions for diagnosis and palliation can be costly and therefore unavailable in large parts of the world. However, there is good evidence to guide clinicians working in low- and middle-income countries on the most cost-effective and clinically effective strategies for the diagnosis and management of MPE. Transthoracic ultrasound-guided closed pleural biopsy is a safe method of pleural biopsy with a diagnostic yield approaching that of thoracoscopy. With the use of pleural fluid cytology and ultrasound-guided biopsy, ≥90% of cases can be diagnosed. Cases with an associated mass lesion are best suited to an ultrasound-guided fine needle aspiration with/without core needle biopsy. Those with diffuse pleural thickening and/or nodularity should have an Abrams needle (<1 cm thickening) or core needle (≥1 cm thickening) biopsy of the area of interest. Those with insignificant pleural thickening should have an ultrasound-guided Abrams needle biopsy close to the diaphragm. The goals of management are to alleviate dyspnoea, prevent re-accumulation of the pleural effusion and minimise re-admissions to hospital. As the most cost-effective strategy, we suggest early use of indwelling pleural catheters with daily drainage for 14 days, followed by talc pleurodesis if the lung expands. The insertion of an intercostal drain with talc slurry is an alternative strategy which is noninferior to thoracoscopy with talc poudrage. Educational aims To provide clinicians practising in resource-constrained settings with a practical evidence-based approach to the diagnosis and management of malignant pleural effusions.To explain how to perform an ultrasound-guided closed pleural biopsy.To explain the cost-effective use of indwelling pleural catheters.
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Affiliation(s)
- Jane A. Shaw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Biomedical Research Institute, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elizabeth H. Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Coenraad F.N. Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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3
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Lung Ultrasound Artifacts Interpreted as Pathology Footprints. Diagnostics (Basel) 2023; 13:diagnostics13061139. [PMID: 36980450 PMCID: PMC10047655 DOI: 10.3390/diagnostics13061139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Background: The original observation that lung ultrasound provides information regarding the physical state of the organ, rather than the anatomical details related to the disease, has reinforced the idea that the observed acoustic signs represent artifacts. However, the definition of artifact does not appear adequate since pulmonary ultrasound signs have shown valuable diagnostic accuracy, which has been usefully exploited by physicians in numerous pathologies. Method: A specific method has been used over the years to analyze lung ultrasound data and to convert artefactual information into anatomical information. Results: A physical explanation of the genesis of the acoustic signs is provided, and the relationship between their visual characteristics and the surface histopathology of the lung is illustrated. Two important sources of potential signal alteration are also highlighted. Conclusions: The acoustic signs are generated by acoustic traps that progressively release previously trapped energy. Consequently, the acoustic signs highlight the presence of acoustic traps and quantitatively describe their distribution on the lung surface; they are not artifacts, but pathology footprints and anatomical information. Moreover, the impact of the dynamic focusing algorithms and the impact of different probes on the visual aspect of the acoustic signs should not be neglected.
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4
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Bediwy AS, Al-Biltagi M, Saeed NK, Bediwy HA, Elbeltagi R. Pleural effusion in critically ill patients and intensive care setting. World J Clin Cases 2023; 11:989-999. [PMID: 36874438 PMCID: PMC9979285 DOI: 10.12998/wjcc.v11.i5.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/14/2023] Open
Abstract
Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses. Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients, with a wide range of variable prevalence rates of up to 50%-60% in some studies. This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit (ICU). The original disease that caused pleural effusion can be the exact cause of ICU admission. There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients. There are also many difficulties in diagnosing pleural effusion in the ICU, including clinical, radiological, and even laboratory difficulties. These difficulties are due to unusual presentation, inability to undergo some diagnostic procedures, and heterogenous results of some of the performed tests. Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients, who usually have frequent comorbidities. Similarly, pleural effusion drainage can modify the ICU-admitted patient’s outcome. Finally, pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.
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Affiliation(s)
- Adel Salah Bediwy
- Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Chest Diseases, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Mohammed Al-Biltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Chairperson of the Pathology Department, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26671, Bahrain
- Microbiology Section, Pathology Department, Royal College of Surgeons in Ireland - Bahrain, Busiateen 15503, Muharraq, Bahrain
| | | | - Reem Elbeltagi
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
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5
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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6
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Smargiassi A, Zanforlin A, Perrone T, Buonsenso D, Torri E, Limoli G, Mossolani EE, Tursi F, Soldati G, Inchingolo R. Vertical Artifacts as Lung Ultrasound Signs: Trick or Trap? Part 2- An Accademia di Ecografia Toracica Position Paper on B-Lines and Sonographic Interstitial Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:279-292. [PMID: 36301623 DOI: 10.1002/jum.16116] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 09/07/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Although during the last few years the lung ultrasound (LUS) technique has progressed substantially, several artifacts, which are currently observed in clinical practice, still need a solid explanation of the physical phenomena involved in their origin. This is particularly true for vertical artifacts, conventionally known as B-lines, and for their use in clinical practice. A wider consensus and a deeper understanding of the nature of these artifactual phenomena will lead to a better classification and a shared nomenclature, and, ultimately, result in a more objective correlation between anatomo-pathological data and clinical scenarios. The objective of this review is to collect and document the different signs and artifacts described in the history of chest ultrasound, with a particular focus on vertical artifacts (B-lines) and sonographic interstitial syndrome (SIS). By reviewing the possible physical and anatomical interpretation of the signs and artifacts proposed in the literature, this work also aims to bring order to the available studies and to present the AdET (Accademia di Ecografia Toracica) viewpoint in terms of nomenclature and clinical approach to the SIS.
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Affiliation(s)
- Andrea Smargiassi
- UOC Pneumologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Zanforlin
- Servizio Pneumologico Aziendale, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Tiziano Perrone
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elena Torri
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Francesco Tursi
- Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy
| | - Gino Soldati
- Ippocrate Medical Center, Castelnuovo di Garfagnana, Lucca, Italy
| | - Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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7
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Livi V, Sotgiu G, Cancellieri A, Paioli D, Leoncini F, Magnini D, Trisolini R. Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial. Cancers (Basel) 2022; 14:cancers14205156. [PMID: 36291940 PMCID: PMC9600579 DOI: 10.3390/cancers14205156] [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: 08/19/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Pulmonologist-performed US-NAB of “superficial” metastatic lesions is safe and has an excellent diagnostic yield for both tissue diagnosis and molecular profiling regardless of the use of rapid on-site evaluation. These findings have important implications for costs, hospital resource allocation, and the globally widespread utilization of US-NAB. Abstract Background and Objective: Studies which evaluated the role of an ultrasound-guided needle aspiration biopsy (US-NAB) of metastases from lung cancer located in “superficial” organs/tissues are scant, and none of them assessed the possible impact of rapid on-site evaluation (ROSE) on diagnostic accuracy and safety outcomes. Methods: Consecutive patients with suspected superficial metastases from lung cancer were randomized 1:1 to US-NAB without (US-NAB group) or with ROSE (ROSE group). The diagnostic yield for a tissue diagnosis was the primary outcome. Secondary outcomes included the diagnostic yield for cancer genotyping, the diagnostic yield for PD-L1 testing, and safety. Results: During the study period, 136 patients were randomized to receive an US-NAB with (n = 68) or without ROSE (n = 68). We found no significant differences between the ROSE group and the US-NAB group in terms of the diagnostic yields for tissue diagnosis (94.1% vs. 97%, respectively; p = 0.68), cancer genotyping (88% vs. 91.8%, respectively; p = 0.56), and PD-L1 testing (93.5% vs. 90.6%, respectively; p = 0.60). Compared to the diagnostic US-NAB procedures, the non-diagnostic procedures were characterized by less common use of a cutting needle (66.6% vs. 96.9%, respectively; p = 0.0004) and less common retrieval of a tissue core (37.5% vs. 98.5%; p = 0.0001). Only one adverse event (vasovagal syncope) was recorded. Conclusion: US-NAB of superficial metastases is safe and has an excellent diagnostic success regardless of the availability of ROSE. These findings provide a strong rationale for using US-NAB as the first-step method for tissue acquisition whenever a suspected superficial metastatic lesion is identified in patients with suspected lung cancer.
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Affiliation(s)
- Vanina Livi
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Alessandra Cancellieri
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Paioli
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Fausto Leoncini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Daniele Magnini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Correspondence:
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8
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Fischer EA, Minami T, Ma IWY, Yasukawa K. Lung Ultrasound for Pleural Line Abnormalities, Confluent B-Lines, and Consolidation: Expert Reproducibility and a Method of Standardization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2097-2107. [PMID: 34845735 DOI: 10.1002/jum.15894] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/30/2021] [Accepted: 11/08/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Discrete B-lines have clear definitions, but confluent B-lines, consolidations, and pleural line abnormalities are less well defined. We proposed definitions for these and determined their reproducibility using COVID-19 patient images obtained with phased array probes. METHODS Two raters collaborated to refine definitions, analyzing disagreements on 107 derivation scans from 10 patients. Refined definitions were used by those raters and an independent rater on 1260 validation scans from 105 patients. Reliability was evaluated using intraclass correlation coefficients (ICC) or Cohen's kappa. RESULTS The agreement was excellent between collaborating raters for B-line abnormalities, ICC = 0.97 (95% confidence interval [CI] 0.97-0.98) and pleural line to consolidation abnormalities, ICC = 0.90 (95% CI 0.87-0.92). The independent rater's agreement for B-line abnormalities was excellent, ICC = 0.97 (95% CI 0.96-0.97) and for pleural line to consolidation was good, ICC = 0.88 (95% CI 0.84-0.91). Agreement just on pleural line abnormalities was weak (collaborators, κ = 0.54, 95% CI 0.48-0.60; independent, κ = 0.54, 95% CI 0.49-0.59). CONCLUSION With proposed definitions or via collaboration, overall agreement on confluent B-lines and pleural line to consolidation abnormalities was robust. Pleural line abnormality agreement itself was persistently weak and caution should be used interpreting pleural line abnormalities with only a phased array probe.
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Affiliation(s)
- Ernest A Fischer
- Division of Hospital Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Taro Minami
- Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Medical Group, Pawtucket, RI, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Irene W Y Ma
- Division of Hospital Medicine, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of General Internal Medicine, University of Calgary, Calgary, AB, Canada
| | - Kosuke Yasukawa
- Division of Ultrasound in Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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9
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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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10
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Operative Use of Thoracic Ultrasound in Respiratory Medicine: A Clinical Study. Diagnostics (Basel) 2022; 12:diagnostics12040952. [PMID: 35454000 PMCID: PMC9030246 DOI: 10.3390/diagnostics12040952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
For over 15 years, thoracic ultrasound has been applied in the evaluation of numerous lung diseases, demonstrating a variable diagnostic predictive power compared to traditional imaging techniques such as chest radiography and CT. However, in unselected pulmonary patients, there are no rigorous scientific demonstrations of the complementarity of thoracic ultrasound with traditional and standardized imaging techniques that use radiation. In this study 101 unselected pulmonary patients were evaluated blindly with ultrasound chest examinations during their hospital stay. Other instrumental examinations, carried out during hospitalization, were standard chest radiography, computed tomography (CT), and, when needed, radioisotopic investigation and cardiac catheterization. The operator who performed the ultrasound examinations was unaware of the anamnestic and clinical data of the patients. Diffuse fibrosing disease was detected with a sensitivity, specificity and diagnostic accuracy of 100%, 95% and 97%, respectively. In pleural effusions, ultrasound showed a sensitivity, specificity and diagnostic accuracy of 100%. In consolidations, the sensitivity, specificity and diagnostic accuracy were 83%, 98% and 93%, respectively. Low values of sensitivity were recorded for surface nodulations of less than one centimeter. Isolated subpleural ground glass densities were identified as White Lung with a sensitivity of 72% and a specificity of 86%. Only the associations Diffuse ultrasound findings/Definitive fibrosing disease, Ultrasound Consolidation/Definitive consolidation and non-diffuse ultrasound artefactual features/Definitive vascular pathology (pulmonary hypertension, embolism) were statistically significant with adjusted residuals of 7.9, 7 and 4.1, respectively. The obtained results show how chest ultrasound is an effective complementary diagnostic tool for the pulmonologist. When performed, as a complement to the patient’s physical examination, it can restrict the diagnostic hypothesis in the case of pleural effusion, consolidation and diffuse fibrosing disease of the lung.
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11
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Zaky S, Fathelbab HK, Elbadry M, El-Raey F, Abd-Elsalam SM, Makhlouf HA, Makhlouf NA, Metwally MA, Ali-Eldin F, Hasan AA, Alboraie M, Yousef AM, Shata HM, Eid A, Asem N, Khalaf A, Elnady MA, Elbahnasawy M, Abdelaziz A, Shaltout SW, Elshemy EE, Wahdan A, Hegazi MS, Abdel Baki A, Hassany M. Egyptian Consensus on the Role of Lung Ultrasonography During the Coronavirus Disease 2019 Pandemic. Infect Drug Resist 2022; 15:1995-2013. [PMID: 36176457 PMCID: PMC9513721 DOI: 10.2147/idr.s353283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background & Aims Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement. Results The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.
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Affiliation(s)
- Samy Zaky
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Elbadry
- Department of Endemic Medicine, Helwan University, Cairo, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Sherief M Abd-Elsalam
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
- Correspondence: Sherief M Abd-Elsalam, Department of Tropical Medicine, Tanta University, Tanta, Egypt, Tel +201063319696, Email
| | | | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Mohamed A Metwally
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Benha University, Benha, Egypt
| | - Fatma Ali-Eldin
- Department of Tropical medicine; Ain Shams University, Cairo, Egypt
| | | | - Mohamed Alboraie
- Department of Internal Medicine; Al-Azhar University, Cairo, Egypt
| | - Ahmed M Yousef
- Department of Community and Industrial Medicine, Damietta, Al-Azhar University, Damietta, Egypt
| | - Hanan M Shata
- Department of Chest Medicine; Mansoura University, Mansoura, Egypt
| | - Alshaimaa Eid
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Cairo University and Ministry of Health and Population, Cairo, Egypt
| | - Asmaa Khalaf
- Department of Radiology, Minia University, Minia, Egypt
| | - Mohamed A Elnady
- Department of Pulmonary Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Elbahnasawy
- Department of Emergency Medicine and Traumatology, Tanta University, Tanta, Egypt
| | - Ahmed Abdelaziz
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Shaker W Shaltout
- Department of Tropical Medicine, Port Said University, Port Said, Egypt
| | - Eman E Elshemy
- Department of Hepatogastroenterology and Infectious Diseases; Al-Azhar University, Cairo, Egypt
| | - Atef Wahdan
- Department of Chest Diseases, Damietta, Al-Azhar University, Damietta, Egypt
| | - Mohamed S Hegazi
- Department of Hepatogastroenterology and Infectious Diseases Al-Azhar University, Damietta, Egypt
| | - Amin Abdel Baki
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
| | - Mohamed Hassany
- Department Hepatology, Gastroenterology and Infectious diseases National Hepatology and Tropical Medicine Research Institute NHTMRI, Cairo, Egypt
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12
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What Is COVID 19 Teaching Us about Pulmonary Ultrasound? Diagnostics (Basel) 2022; 12:diagnostics12040838. [PMID: 35453889 PMCID: PMC9027485 DOI: 10.3390/diagnostics12040838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 12/12/2022] Open
Abstract
In lung ultrasound (LUS), the interactions between the acoustic pulse and the lung surface (including the pleura and a small subpleural layer of tissue) are crucial. Variations of the peripheral lung density and the subpleural alveolar shape and its configuration are typically connected to the presence of ultrasound artifacts and consolidations. COVID-19 pneumonia can give rise to a variety of pathological pulmonary changes ranging from mild diffuse alveolar damage (DAD) to severe acute respiratory distress syndrome (ARDS), characterized by peripheral bilateral patchy lung involvement. These findings are well described in CT imaging and in anatomopathological cases. Ultrasound artifacts and consolidations are therefore expected signs in COVID-19 pneumonia because edema, DAD, lung hemorrhage, interstitial thickening, hyaline membranes, and infiltrative lung diseases when they arise in a subpleural position, generate ultrasound findings. This review analyzes the structure of the ultrasound images in the normal and pathological lung given our current knowledge, and the role of LUS in the diagnosis and monitoring of patients with COVID-19 lung involvement.
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13
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Normalising lung ultrasound. Afr J Thorac Crit Care Med 2022; 28:10.7196/AJTCCM.2022.v28i4.289. [PMID: 36911654 PMCID: PMC9994625 DOI: 10.7196/ajtccm.2022.v28i4.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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Campagnano S, Angelini F, Fonsi GB, Novelli S, Drudi FM. Diagnostic imaging in COVID-19 pneumonia: a literature review. J Ultrasound 2021; 24:383-395. [PMID: 33590456 PMCID: PMC7884066 DOI: 10.1007/s40477-021-00559-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
In December 2019 in Wuhan (China), a bat-origin coronavirus (2019-nCoV), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified, and the World Health Organization named the related disease COVID-19. Its most severe manifestations are pneumonia, systemic and pulmonary thromboembolism, acute respiratory distress syndrome (ARDS), and respiratory failure. A swab test is considered the gold standard for the diagnosis of COVID-19 despite the high number of false negatives. Radiologists play a crucial role in the rapid identification and early diagnosis of pulmonary involvement. Lung ultrasound (LUS) and computed tomography (CT) have a high sensitivity in detecting pulmonary interstitial involvement. LUS is a low-cost and radiation-free method, which allows a bedside approach and needs disinfection of only a small contact area, so it could be particularly useful during triage and in intensive care units (ICUs). High-resolution computed tomography (HRCT) is particularly useful in evaluating disease progression or resolution, being able to identify even the smallest changes.
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Affiliation(s)
- Sarah Campagnano
- Department of Radiological, Oncological and Path Sciences, Sapienza University of Rome, Rome, Italy
| | - Flavia Angelini
- Department of Radiological, Oncological and Path Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Simone Novelli
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Francesco Maria Drudi
- Department of Radiological, Oncological and Path Sciences, Sapienza University of Rome, Rome, Italy.
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15
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Abstract
Pleural tuberculosis (TB) is common and often follows a benign course but may result in serious long-term morbidity. Diagnosis is challenging because of the paucibacillary nature of the condition. Advances in Mycobacterium culture media and PCR-based techniques have increased the yield from mycobacteriologic tests. Surrogate biomarkers perform well in diagnostic accuracy studies but must be interpreted in the context of the pretest probability in the individual patient. Confirming the diagnosis often requires biopsy, which may be acquired through thoracoscopy or image-guided closed pleural biopsy. Treatment is standard anti-TB therapy, with optional drainage and intrapleural fibrinolytics or surgery in complicated cases.
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Affiliation(s)
- Jane A Shaw
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa.
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, PO Box 241, Cape Town 8000, South Africa
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16
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Shiroshita A, Nozaki S, Tanaka Y, Luo Y, Kataoka Y. Thoracic ultrasound for malignant pleural effusion: a systematic review and meta-analysis. ERJ Open Res 2020; 6:00464-2020. [PMID: 33263053 PMCID: PMC7682705 DOI: 10.1183/23120541.00464-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/02/2020] [Indexed: 12/23/2022] Open
Abstract
This systematic review aimed to evaluate the diagnostic accuracy of thoracic ultrasound in malignant pleural effusion. Articles published until December 2019 in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the International Clinical Trials Registry Platform were screened by two authors independently to extract data and evaluate the risks of bias and applicability using the modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. We described the forest plots of each thoracic ultrasound finding. We estimated the pooled sensitivity and specificity of pleural nodularity using the bivariate random-effects model. We included seven articles and found that each thoracic ultrasound finding had low sensitivity. The pooled specificity of pleural nodularity was 96.9% (95% CI 93.2%–98.6%). In conclusion, thoracic ultrasound is not useful in ruling out malignant pleural effusion. Physicians can proceed rigorously to repeat thoracentesis or other invasive procedures when pleural nodularity is detected. This systematic review shows that thoracic ultrasound cannot rule out malignant pleural effusion. Pleural nodularity could be a ruling-in test for performing repeated thoracentesis or other invasive procedures when malignant pleural effusion is suspected.https://bit.ly/3iuM5z7
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Affiliation(s)
- Akihiro Shiroshita
- Dept of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, Japan.,Dept of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Sayumi Nozaki
- Post Graduate Education Center, Kameda Medical Center, Kamogawa, Japan
| | - Yu Tanaka
- Dept of Pulmonology, Kameda Medical Center, Kamogawa, Japan
| | - Yan Luo
- Dept of Health Promotion and Human Behavior, Graduate School of Medicine, Kyoto University, Kyoto Japan
| | - Yuki Kataoka
- Dept of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.,Dept of Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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17
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Sultan LR, Sehgal CM. A Review of Early Experience in Lung Ultrasound in the Diagnosis and Management of COVID-19. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2530-2545. [PMID: 32591166 PMCID: PMC7247506 DOI: 10.1016/j.ultrasmedbio.2020.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 05/03/2023]
Abstract
A novel coronavirus (2019-nCoV) was identified as the cause of a cluster of pneumonia in Wuhan, China, at the end of 2019. Since then more than eight million confirmed cases of coronavirus disease 2019 (COVID-19) have been reported around the globe. The current gold standard for etiologic diagnosis is reverse transcription-polymerase chain reaction analysis of respiratory-tract specimens, but the test has a high false-negative rate owing to both nasopharyngeal swab sampling error and viral burden. Hence diagnostic imaging has emerged as a fundamental component of current management of COVID-19. Currently, high-resolution computed tomography is the main imaging tool for primary diagnosis and evaluation of disease severity in patients. Lung ultrasound (LUS) imaging has become a safe bedside imaging alternative that does not expose the patient to radiation and minimizes the risk of contamination. Although the number of studies to date is limited, LUS findings have demonstrated high diagnostic sensitivity and accuracy, comparable with those of chest computed tomography scans. In this note we review the current state of the art of LUS in evaluating pulmonary changes induced by COVID-19. The goal is to identify characteristic sonographic findings most suited for the diagnosis of COVID-19 pneumonia infections.
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Affiliation(s)
- Laith R Sultan
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Chandra M Sehgal
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Lin Z, Wu D, Wang J, Wang C, Huang M. Diagnostic value of ultrasound-guided needle biopsy in undiagnosed pleural effusions: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21076. [PMID: 32629740 PMCID: PMC7337470 DOI: 10.1097/md.0000000000021076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Undiagnosed pleural effusions (UPEs) are a common problem of respiratory medicine, leading to an increased diagnostic burden globally. However, the most efficient and cost-effective approaches to UPEs remain controversial. This study aimed to assess the diagnostic value of ultrasound-guided needle biopsy (UGNB) in UPEs. METHODS We conducted a search of PubMed, Embase, the Cochrane Library and reference lists of retrieved studies with no publication data limitation. Articles that investigated the diagnostic accuracy of UGNB in UPEs were included. The quality of eligible studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic value of UGNB was evaluated by calculating the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds rate, and the area under the curve for the summary receiver operating characteristic curve using a random effects model. RESULTS Seven studies comprising 165 patients with UPEs met the inclusion criteria. UGNB had a pooled sensitivity of 83% (95% confidence intervals [CI], 75% - 89%), a specificity of 100% (95% CI, 90% - 100%), a positive likelihood ratio of 8.89 (95% CI, 3.29 - 24.02), a negative likelihood ratio of 0.23 (95% CI, 0.16 - 0.33), a diagnostic odds rate of 51.47 (95% CI, 14.70 - 180.16), and an area under the curve of 0.94. Six pneumothorax cases (3.6%), 5 local wound infections (3.0%), and 1 empyema case (less than 1%) were observed. There was no significant heterogeneity or publication bias in this study. CONCLUSIONS Based on current evidence, UGNB is a safe and convenient procedure with a high accuracy for diagnosing UPEs. However, physicians should still be cautious in interpreting negative UGNB results.
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Affiliation(s)
- Zhidi Lin
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Donghong Wu
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinlin Wang
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
| | - Chuqiao Wang
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingkai Huang
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
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19
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Aplicaciones clínicas de la ecografía pulmonar. Med Clin (Barc) 2020; 154:260-268. [DOI: 10.1016/j.medcli.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 12/28/2022]
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20
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Demi M, Prediletto R, Soldati G, Demi L. Physical Mechanisms Providing Clinical Information From Ultrasound Lung Images: Hypotheses and Early Confirmations. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:612-623. [PMID: 31670665 DOI: 10.1109/tuffc.2019.2949597] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In standard B mode imaging, a set of ultrasound pulses is used to reconstruct a 2-D image even though some of the assumptions needed to do this are not fully satisfied. For this reason, ultrasound medical images show numerous artifacts which physicians recognize and evaluate as part of their diagnosis since even one artifact can provide clinical information. Understanding the physical mechanisms at the basis of the formation of an artifact is important to identify the physiopathological state of the biological medium which generated the artifact. Ultrasound lung images are a significant example of this challenge since everything that is represented beyond the thickness of the chest wall ( ≈ 2 cm) is artifactual information. A convincing physical explanation of the genesis of important ultrasound lung artifacts does not exist yet. Physicians simply base their diagnosis on a correlation observed over the years between the manifestation of some artifacts and the occurrence of particular lung pathologies. In this article, a plausible genesis of some important lung artifacts is suggested.
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21
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Artifactual Lung Ultrasonography: It Is a Matter of Traps, Order, and Disorder. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10051570] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
When inspecting the lung with standard ultrasound B-mode imaging, numerous artifacts can be visualized. These artifacts are useful to recognize and evaluate several pathological conditions in Emergency and Intensive Care Medicine. More recently, the interest of the Pulmonologists has turned to the echographic study of the interstitial pathology of the lung. In fact, all lung pathologies which increase the density of the tissue, and do not consolidate the organ, are characterized by the presence of ultrasound artifacts. Many studies of the past have only assessed the number of vertical artifacts (generally known as B-Lines) as a sign of disease severity. However, recent observations suggest that the appearance of the individual artifacts, their variability, and their internal structure, may play a role for a non-invasive characterization of the surface of the lungs, directing the diagnoses and identifying groups of diseases. In this review, we discuss the meaning of lung ultrasound artifacts, and introduce hypothesis on the correlation between their presence and the structural variation of the sub-pleural tissue in light of current knowledge of the acoustic properties of the pleural plane.
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22
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Shaw JA, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusion. Respirology 2019; 24:962-971. [PMID: 31418985 DOI: 10.1111/resp.13673] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Abstract
Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti-tuberculous therapy or a guideline-based individualized regimen in the case of drug resistance. There is low-quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short- and long-term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.
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Affiliation(s)
- Jane A Shaw
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - Andreas H Diacon
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
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23
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Prospective Study of the Utility of Computed Tomography Triage of Pleural Biopsy Strategies in Patients With Pleural Diseases. J Bronchology Interv Pulmonol 2019; 26:210-218. [PMID: 31211722 DOI: 10.1097/lbr.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study aimed to prospectively evaluate the efficacy and reliability of a diagnostic workup, triaging pleural biopsy method according to baseline computerized tomography (CT) findings in the diagnosis of pleural diseases. METHODS Patients with pleural pathology were divided into 3 arms according to findings on CT scan images. Arm A: patients with pleural thickening/lesion in addition to pleural effusion. These patients underwent CT scan-guided Abrams' needle pleural biopsy. Arm B: patients with pleural effusion alone or suspected benign asbestos pleurisy. This group underwent medical thoracoscopy (MT). Arm C: patients with only pleural thickening. This group underwent ultrasonography-guided cutting needle pleural biopsy. MT was planned in patients who did not have a specific diagnosis in the CT scan-guided Abrams' needle pleural biopsy group. When patients with a histopathologic diagnosis of fibrinous pleuritis after MT were assessed in terms of the risk factors for malignant pleural diseases, we offered a further invasive procedure. RESULTS A total of 164 patients were enrolled in the study. Diagnostic sensitivity after the initial procedure was 90.2% in Arm A, 93.3% in Arm B, 95.2% in Arm C, and 92.4% in the entire workup. The negative predictive value of the entire workup was 90.4% for malignant pleural mesothelioma, 97.1% for metastatic malignant pleural diseases, and 100% for tuberculous pleurisy. Five cases who had a diagnosis of fibrinous pleuritis after MT were detected to have risk factors, 4 of which (80%) indicated malignant disease. Complication rates were low and acceptable. CONCLUSION Use of CT scans to triage an appropriate pleural biopsy method is associated with high diagnostic success. We recommend that the proposed diagnostic workup in this study may be used as a diagnostic algorithm for pleural diseases that require a histopathologic analysis. Determination of risk factors predicting malignant disease in patients where fibrinous pleuritis is reported after MT would be useful for clinical practice.
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24
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Lesser TG. Significance of chest ultrasound in the early postoperative period following thoracic surgery. J Thorac Dis 2019; 11:S352-S353. [PMID: 30997218 DOI: 10.21037/jtd.2018.12.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas G Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of the University Hospital of Jena, Gera, Germany
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25
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Smargiassi A, Inchingolo R, Chiappetta M, Ciavarella LP, Lopatriello S, Corbo GM, Margaritora S, Richeldi L. Agreement between chest ultrasonography and chest X-ray in patients who have undergone thoracic surgery: preliminary results. Multidiscip Respir Med 2019; 14:9. [PMID: 30867907 PMCID: PMC6398240 DOI: 10.1186/s40248-019-0171-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background Chest Ultrasonography (chest US) has shown good sensibility in detecting pneumothorax, pleural effusions and peripheral consolidations and it can be performed bedside. Objectives The aim of the study was to analyze agreement between chest US and chest X-ray in patients who have undergone thoracic surgery and discuss cases of discordance. Methods Patients undergoing thoracic surgery were retrospectively selected. Patients underwent routinely Chest X-ray (CXR) during the first 48 h after surgery. Chest US have been routinely performed in all selected patients in the same date of CXR. Chest US operators were blind to both reports and images of CXR. Ultrasonographic findings regarding pneumothorax (PNX), subcutaneous emphysema (SCE), lung consolidations (LC), pleural effusions (PE) and hemi-diaphragm position were collected and compared to corresponding CXR findings. Inter-rater agreement between two techniques was determined by Cohen's kappa-coefficient. Results Twenty-four patients were selected. Inter-rater agreement showed a moderate magnitude for PNX (Cohen's Kappa 0.5), a slight/fair magnitude for SCE (Cohen's Kappa 0.21), a fair magnitude for PE (Cohen's Kappa 0.39), no agreement for LCs (Cohen's Kappa 0.06), high levels of agreement for position of hemi-diaphragm (Cohen's Kappa 0.7). Conclusion Analysis of agreement between chest X-ray and chest US showed that ultrasonography is able to detect important findings for surgeons. Limitations and advantages have been found for both chest X-ray and chest US. Knowing the limits of each one is important to really justify and optimize the use of ionizing radiations.
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Affiliation(s)
- Andrea Smargiassi
- 1Respiratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Inchingolo
- 1Respiratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Chiappetta
- 2Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Stefania Lopatriello
- 1Respiratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Maria Corbo
- 1Respiratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,3Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- 2Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,3Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Richeldi
- 1Respiratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,3Università Cattolica del Sacro Cuore, Rome, Italy
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26
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Soldati G, Demi M, Smargiassi A, Inchingolo R, Demi L. The role of ultrasound lung artifacts in the diagnosis of respiratory diseases. Expert Rev Respir Med 2019; 13:163-172. [PMID: 30616416 DOI: 10.1080/17476348.2019.1565997] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Thoracic ultrasound is employed for the diagnosis of many thoracic diseases and is an accepted detection tool of pleural effusions, atelectasis, pneumothorax, and pneumonia. However, the use of ultrasound for the evaluation of parenchymal lung disease, when the organ is still aerated, is a relatively new application. Areas covered: The diagnosis of a normal lung and the differentiation between a normally aerated lung and a lung with interstitial pathology is based on the interpretation of ultrasound artifacts universally known as A and B-Lines. Even though the practical role of lung ultrasound artifacts is accepted by many clinicians, their physical basis and the correlations between these signs and the causal pathology is not known in depth. Expert commentary: In this review, we discuss the meaning of A- and B-Lines in the diagnostic ultrasound imaging of the lung and the acoustic properties of the pleural plane which are at the basis of their generation.
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Affiliation(s)
- Gino Soldati
- a Diagnostic and Interventional Ultrasound Unit , Valle del Serchio General Hospital , Lucca , Italy
| | - Marcello Demi
- b Department of Medical Image Processing , fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | | | | | - Libertario Demi
- d Department of Information Engineering and Computer Science , University of Trento , Trento , Italy
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Shaw J, Koegelenberg C. Muddied Waters: Echogenic Pleural Transudates Do Exist! Respiration 2019; 97:403-405. [DOI: 10.1159/000496706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Shaw JA, Irusen EM, Diacon AH, Koegelenberg CF. Pleural tuberculosis: A concise clinical review. CLINICAL RESPIRATORY JOURNAL 2018; 12:1779-1786. [PMID: 29660258 DOI: 10.1111/crj.12900] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/23/2018] [Accepted: 04/04/2018] [Indexed: 12/18/2022]
Abstract
Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. TB pleurisy can also present as loculated neutrophil-predominant effusions which mimic parapneumonic effusions. Rarely, they can present as frank TB empyema, containing an abundance of mycobacteria. Up to 80% of patients have parenchymal involvement on chest imaging. The diagnosis is simple if M. tuberculosis is detected in sputum, pleural fluid or biopsy specimens, and the recent advent of liquid medium culture techniques has increased the microbiological yield dramatically. Where the prevalence of TB is high the presence of a lymphocyte-predominant exudate with a high ADA has a positive predictive value of 98%. In low prevalence areas, the absence of an elevated ADA and lymphocyte predominance makes TB very unlikely, and pleural biopsy should be performed to confirm the diagnosis. Pleural biopsy for liquid culture and susceptibility testing must also be considered where the prevalence of drug resistant TB is high. Treatment regimens are identical to those administered for pulmonary TB. Initial pleural drainage may have a role in symptom relief and in hastening the resolution of the effusion. Surgical intervention may be required in loculated effusions and empyemas.
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Affiliation(s)
- Jane A Shaw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Elvis M Irusen
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Andreas H Diacon
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Coenraad F Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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Zhang Y, Tang J, Zhou X, Zhou D, Wang J, Tang Q. Ultrasound-guided pleural cutting needle biopsy: accuracy and factors influencing diagnostic yield. J Thorac Dis 2018; 10:3244-3252. [PMID: 30069320 DOI: 10.21037/jtd.2018.05.94] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background The aim of this study was to retrospectively investigate the diagnostic accuracy of ultrasound-guided pleural cutting needle biopsy (US-guided PCNB) and the potential factors influencing diagnostic yield. Methods From July 2014 to June 2016, a total of 147 percutaneous US-guided PCNBs in 144 patients were retrospectively reviewed. The final diagnosis was confirmed by histopathological analysis and follow-up. We calculated diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and divided all cases into group of correct diagnoses (true-positive and true-negative cases) and group of incorrect diagnoses (false-positive, false-negative, and inconclusive cases). Univariate and multivariate logistic regression analyses were performed to analyze the differences of influencing factors (patient, pleura, and biopsy-associated factors) in the between the two groups. Results Seven patients were excluded because of loss to follow-up. A total of 140 cases were ultimately included (105 males and 35 females). There were 105 cases in the correct diagnosis group, and 35 cases in the incorrect diagnosis group. The overall accuracy of US-PCNB was 75.0% and the sensitivity, specificity, PPV, NPV in malignant diagnosis were 58.1%, 99.0%, 96.2%, and 84.2%, respectively. On univariate analysis, variables affecting diagnostic accuracy of US-PCNB were the pleural thickness (<3 mm in thickness 61.0%, ≥3 mm in thickness 85.2%; P=0.001), morphology (non-nodular pleura 71.4%, nodular pleura 95.2%; P=0.026), and needle size (18 G 69.1%, 16 G 87.0%; P=0.022). Finally multivariate logistic regression demonstrated that pleural thickness [odds ratio (OR): 0.278, P=0.003] and needle size (OR: 0.291, P=0.018) independently predicted diagnostic accuracy. Conclusions Pleural thickness and the size of the biopsy needle were significantly correlated with the diagnostic yield.
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Affiliation(s)
- Yuxin Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jiaxin Tang
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xinghua Zhou
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Dazhi Zhou
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jinlin Wang
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qing Tang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Shaw J, Koegelenberg C. Exeunt Lateral Decubitus Radiographs. Respiration 2018; 95:403-404. [DOI: 10.1159/000488803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Lei Z, Lou J, Bao L, Lv Z. Contrast-enhanced ultrasound for needle biopsy of central lung cancer with atelectasis. J Med Ultrason (2001) 2017; 45:461-467. [PMID: 29243129 DOI: 10.1007/s10396-017-0851-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/10/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) can distinguish between central lung cancer and atelectatic lung tissue. The aim of this study was to explore the clinical value of CEUS for biopsy in patients with central lung cancer with obstructive atelectasis. METHODS One hundred and twelve patients were selected and CEUS was performed to display central lung cancer and atelectatic lung tissue. The front edge of central lung cancer was punctured with a needle, avoiding the necrotic area, under the guidance of CEUS. RESULTS All of the 112 lesions were diagnosed with a clear central lung cancer mass and atelectatic lung tissue. In 104 cases, the central lung cancer mass presented with a "slow-in and fast-out" pattern compared to atelectatic lung tissue. In eight cases, the central lung cancer mass presented with a "fast-in and fast-out" pattern compared to atelectatic lung tissue. The mean number of punctures was 2.6, and the success rate of puncture biopsy was 98%. Of the 112 patients, six cases had hemoptysis during the procedure and 10 patients had bloody sputum in the postoperative period. No complications were found in the other cases. CONCLUSION CEUS has important clinical value for needle biopsy of central lung cancer with atelectasis.
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Affiliation(s)
- Zhikai Lei
- Department of Ultrasound, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
| | - Jun Lou
- Department of Ultrasound, Hangzhou Tumor Hospital, Hangzhou, China
| | - Lingyun Bao
- Department of Ultrasound, Hangzhou First People's Hospital, Hangzhou, China
| | - Zhuying Lv
- Department of Ultrasound, Hangzhou Tumor Hospital, Hangzhou, China
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Conte EG, Gerardi RE, Smargiassi A, Gatto A, Valentini P, Nanni L, Inchingolo R. A 3-Year-Old Child With a History of Persistent Dry Cough and Fever. Chest 2017; 151:e127-e129. [PMID: 28599945 DOI: 10.1016/j.chest.2016.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/23/2016] [Accepted: 12/20/2016] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Andrea Smargiassi
- Department of Pulmonary Medicine, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Antonio Gatto
- Institute of Pediatrics, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Piero Valentini
- Institute of Pediatrics, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Lorenzo Nanni
- Institute of Pediatric Surgery, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Riccardo Inchingolo
- Department of Pulmonary Medicine, Policlinico Universitario Agostino Gemelli, Rome, Italy
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Smargiassi A, Pasciuto G, Pedicelli I, Lo Greco E, Calvello M, Inchingolo R, Schifino G, Capoluongo P, Patriciello P, Manno M, Cirillo A, Corbo GM, Soldati G, Iavicoli I. Chest ultrasonography in health surveillance of asbestos-related lung diseases. Toxicol Ind Health 2017; 33:537-546. [DOI: 10.1177/0748233716686916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: Exposure to asbestos fibers can lead to different lung diseases, such as pleural thickening and effusion, asbestosis, mesothelioma, and lung cancer. These diseases are expected to peak in the next few years. The aim of the study was to validate ultrasonography (US) as a diagnostic tool in the management of lung diseases in subjects with a history of occupational exposure to asbestos. Methods: Fifty-nine retired male workers previously exposed to asbestos were enrolled in the study. Chest US was performed in all the subjects. The US operator was blinded to earlier performed computed tomography (CT) scan reports and images. The sonographic pathological findings were pleural thickening (with or without calcifications), peripheral lung consolidation, and focal sonographic interstitial syndrome and diffuse pneumogenic sonographic interstitial syndrome (pulmonary asbestosis). Significant US findings were recorded, stored, and subsequently compared with CT scans. Results: With some patients falling into more than one category, on CT scan, pleural thickening was reported in 33 cases (56%, 26 with calcifications), focal interstitial peripheral alterations in 23 (39%), asbestosis in 6 (10%), and peripheral lung consolidation in 13 cases (22%). Comparing each pathological condition to CT scan reports, US findings had high levels of sensitivity, specificity, positive, and negative predictive values. US did not prove effective for the detection of central lung nodules or diaphragmatic pleural thickenings. Chest US was considered to be the best technique to detect minimal pleural effusions (six subjects, 10%). Conclusions: Chest US might be considered an additional tool to follow up subjects occupationally exposed to asbestos who have already undergone CT scan examination and whose pathology is detectable by US as well.
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Affiliation(s)
- Andrea Smargiassi
- Pulmonary Medicine Department, University Hospital “A. Gemelli”—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuliana Pasciuto
- Pulmonary Medicine Department, University Hospital “A. Gemelli”—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Pedicelli
- Pulmonary Medicine Department, OORR Area Nolana—ASL Napoli3 Sud, Pollena Trocchia, Italy
| | - Erminia Lo Greco
- Pulmonary Medicine Department, University Hospital “A. Gemelli”—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariarosaria Calvello
- Pulmonary Medicine Department, University Hospital “A. Gemelli”—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Inchingolo
- Pulmonary Medicine Department, University Hospital “A. Gemelli”—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gioacchino Schifino
- Pulmonary Medicine Department, University Hospital “A. Gemelli”—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizio Capoluongo
- Department of Public Health, University of Naples—Federico II, Naples, Italy
| | - Pasquale Patriciello
- Pulmonary Medicine Department, OORR Area Nolana—ASL Napoli3 Sud, Pollena Trocchia, Italy
| | - Maurizio Manno
- Department of Public Health, University of Naples—Federico II, Naples, Italy
| | - Alfonso Cirillo
- Department of Prevention, Service of Hygiene and Occupational Medicine—ASL Napoli3 Sud, Pompei, Italy
| | - Giuseppe Maria Corbo
- Pulmonary Medicine Department, University Hospital “A. Gemelli”—Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gino Soldati
- Emergency Department, Valle del Serchio General Hospital, Castelnuovo Garfagnana, Italy
| | - Ivo Iavicoli
- Department of Public Health, University of Naples—Federico II, Naples, Italy
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Madsen KR, Høegholm A, Bodtger U. Accuracy and consequences of same-day, invasive lung cancer workup - a retrospective study in patients treated with surgical resection. Eur Clin Respir J 2016; 3:32590. [PMID: 27914192 PMCID: PMC5134828 DOI: 10.3402/ecrj.v3.32590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/08/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Though widely used, little is known about accuracy and efficacy of same-day, invasive workup of suspected lung cancer. OBJECTIVE To evaluate the accuracy and efficacy of same-day, invasive lung cancer workup (diagnosis and mediastinal staging), and to identify differences between patients without (Group A) or with (Group B) need for resampling. METHODS A retrospective study was performed on all consecutive patients referred for surgical treatment for localised lung cancer after invasive diagnostic and staging workup at our unit. Data were extracted from electronic medical files. Surgical specimens served as gold standard for correct diagnosis and stage. RESULTS A total of 129 patients (peripheral lesion: 84%; mediastinal staging: 97%) were included. After same-day, invasive workup, 71% had no need for further invasive workup (Group A), while 29% had (Group B). Group A differed significantly from Group B in fewer invasive tests, fewer days from referral to surgery, and lower pneumothorax incidence, while no differences were observed in diagnostic accuracy, cancer subtype, tumour size, tumour stage, peripheral lesion, nodal involvement, gender, or presence of chronic obstructive pulmonary disease. Tumour located in right upper lobe was associated with need for resampling. DISCUSSION Our retrospective study suggests that same-day, invasive workup for lung cancer is safe, accurate, and efficacious in reducing time to therapy, even in patients with small lesions and low tumour burden.
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Affiliation(s)
- Kirsten Riis Madsen
- Department of Internal and Respiratory Medicine, Naestved Hospital, Naestved, Denmark
| | - Asbjørn Høegholm
- Department of Internal and Respiratory Medicine, Naestved Hospital, Naestved, Denmark
| | - Uffe Bodtger
- Department of Internal and Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark;
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Hammerschlag G, Denton M, Wallbridge P, Irving L, Hew M, Steinfort D. Accuracy and safety of ward based pleural ultrasound in the Australian healthcare system. Respirology 2016; 22:508-512. [PMID: 27805286 DOI: 10.1111/resp.12932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/04/2016] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound has been shown to improve the accuracy and safety of pleural procedures. Studies to date have been performed in large, specialized units, where pleural procedures are performed by a small number of highly specialized physicians. There are no studies examining the safety and accuracy of ultrasound in the Australian healthcare system where procedures are performed by junior doctors with a high staff turnover. METHODS We performed a retrospective review of the ultrasound database in the Respiratory Department at the Royal Melbourne Hospital to determine accuracy and complications associated pleural procedures. RESULTS A total of 357 ultrasounds were performed between October 2010 and June 2013. Accuracy of pleural procedures was 350 of 356 (98.3%). Aspiration of pleural fluid was successful in 121 of 126 (96%) of patients. Two (0.9%) patients required chest tube insertion for management of pneumothorax. There were no recorded pleural infections, haemorrhage or viscera puncture. CONCLUSION Ward-based ultrasound for pleural procedures is safe and accurate when performed by appropriately trained and supported junior medical officers. Our findings support this model of pleural service care in the Australian healthcare system.
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Affiliation(s)
- Gary Hammerschlag
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Matthew Denton
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Wallbridge
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark Hew
- Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Steinfort
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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36
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Pleural ultrasound for clinicians. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Soldati G, Demi M, Inchingolo R, Smargiassi A, Demi L. On the Physical Basis of Pulmonary Sonographic Interstitial Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2075-86. [PMID: 27503755 DOI: 10.7863/ultra.15.08023] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Gino Soldati
- Emergency Medicine Unit, Valle del Serchio General Hospital, Lucca, Italy
| | - Marcello Demi
- Department of Medical Image Processing, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Riccardo Inchingolo
- Department of Pulmonary Medicine, A. Gemelli University Hospital, Rome, Italy
| | - Andrea Smargiassi
- Department of Pulmonary Medicine, A. Gemelli University Hospital, Rome, Italy
| | - Libertario Demi
- Laboratory of Biomedical Diagnostics, Eindhoven University of Technology, Eindhoven, the Netherlands
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38
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Porcel JM. Pleural ultrasound for clinicians. Rev Clin Esp 2016; 216:427-435. [PMID: 27282205 DOI: 10.1016/j.rce.2016.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 01/13/2023]
Abstract
Pleural ultrasonography is useful for identifying and characterising pleural effusions, solid pleural lesions (nodules, masses, swellings) and pneumothorax. Pleural ultrasonography is also considered the standard care for guiding interventionist procedures on the pleura at the patient's bedside (thoracentesis, drainage tubes, pleural biopsies and pleuroscopy). Hospitals should promote the acquisition of portable ultrasound equipment to increase the patient's safety.
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Affiliation(s)
- J M Porcel
- Unidad de Medicina Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Instituto de Investigación Biomédica de Lleida Fundación Dr. Pifarré (IRBLLEIDA), Lleida, España.
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Metintas M, Yildirim H, Kaya T, Ak G, Dundar E, Ozkan R, Metintas S. CT Scan-Guided Abrams' Needle Pleural Biopsy versus Ultrasound-Assisted Cutting Needle Pleural Biopsy for Diagnosis in Patients with Pleural Effusion: A Randomized, Controlled Trial. Respiration 2016; 91:156-63. [DOI: 10.1159/000443483] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022] Open
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40
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Metintas M, Yildirim H, Kaya T, Ak G, Dundar E, Ozkan R, Metintas S. Authors' Reply. Respiration 2016; 92:57. [DOI: 10.1159/000447563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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41
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Dietrich CF, Annema JT, Clementsen P, Cui XW, Borst MM, Jenssen C. Ultrasound techniques in the evaluation of the mediastinum, part I: endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques. J Thorac Dis 2015; 7:E311-25. [PMID: 26543620 DOI: 10.3978/j.issn.2072-1439.2015.09.40] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [EBUS combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [EUS fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all mediastinal lymph nodes can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review, in two integrative parts, is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part I is dealing with an introduction into ultrasound techniques, mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques and part II with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christoph Frank Dietrich
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Jouke Tabe Annema
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Paul Clementsen
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Xin Wu Cui
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Mathias Maximilian Borst
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - Christian Jenssen
- 1 Medical Department 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Denmark and Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 4 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany ; 5 Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
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Vorster MJ, Allwood BW, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusions: advances and controversies. J Thorac Dis 2015; 7:981-91. [PMID: 26150911 DOI: 10.3978/j.issn.2072-1439.2015.02.18] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/29/2015] [Indexed: 12/11/2022]
Abstract
On a global scale, tuberculosis (TB) remains one of the most frequent causes of pleural effusions. Our understanding of the pathogenesis of the disease has evolved and what was once thought to be an effusion as a result of a pure delayed hypersensitivity reaction is now believed to be the consequence of direct infection of the pleural space with a cascade of events including an immunological response. Pulmonary involvement is more common than previously believed and induced sputum, which is grossly underutilised, can be diagnostic in approximately 50%. The gold standard for the diagnosis of tuberculous pleuritis remains the detection of Mycobacterium tuberculosis in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli (AFB). In high burden settings, however, the diagnosis is frequently inferred in patients who present with a lymphocytic predominant exudate and a high adenosine deaminase (ADA) level, which is a valuable adjunct in the diagnostic evaluation. ADA is generally readily accessible, and together with lymphocyte predominance justifies treatment initiation in patients with a high pre-test probability. Still, false-negative and false-positive results remain an issue. When adding closed pleural biopsy to ADA and lymphocyte count, diagnostic accuracy approaches that of thoracoscopy. The role of other biomarkers is less well described. Early pleural drainage may have a role in selected cases, but more research is required to validate its use and to define the subpopulation that may benefit from such interventions.
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Affiliation(s)
- Morné J Vorster
- Department of Medicine, Divisions of Pulmonology, Stellenbosch University & Tygerberg Academic Hospital, Cape Town 8000, South Africa
| | - Brian W Allwood
- Department of Medicine, Divisions of Pulmonology, Stellenbosch University & Tygerberg Academic Hospital, Cape Town 8000, South Africa
| | - Andreas H Diacon
- Department of Medicine, Divisions of Pulmonology, Stellenbosch University & Tygerberg Academic Hospital, Cape Town 8000, South Africa
| | - Coenraad F N Koegelenberg
- Department of Medicine, Divisions of Pulmonology, Stellenbosch University & Tygerberg Academic Hospital, Cape Town 8000, South Africa
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Abstract
The scope of lung ultrasound (LUS) in emergency and critical care settings has been studied extensively. LUS is easily available at bedside, free of radiation hazard and real time. All these features make it useful in reducing need of bedside X-rays and CT scan of chest. LUS has been proven to be superior to the bedside chest X-ray and equal to chest CT in diagnosing many pleural and lung pathologies. The first International Consensus Conference on Lung Ultrasound (ICC-LUS) has given recommendations for unified approach and language in major six areas of LUS. The LUS diagnosis is to be given after integration of findings of both lungs. The BLUE protocol is first LUS-based systematic approach in diagnosing pleural and lung pathologies. The protocol suggested in this article includes history and conventional clinical assessment along with LUS features.
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Affiliation(s)
- Ashish Saraogi
- Department of Anaesthesiology, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India
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44
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Dietrich CF, Mathis G, Cui XW, Ignee A, Hocke M, Hirche TO. Ultrasound of the pleurae and lungs. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:351-365. [PMID: 25592455 DOI: 10.1016/j.ultrasmedbio.2014.10.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 09/24/2014] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
The value of ultrasound techniques in examination of the pleurae and lungs has been underestimated over recent decades. One explanation for this is the assumption that the ventilated lungs and the bones of the rib cage constitute impermeable obstacles to ultrasound. However, a variety of pathologies of the chest wall, pleurae and lungs result in altered tissue composition, providing substantially increased access and visibility for ultrasound examination. It is a great benefit that the pleurae and lungs can be non-invasively imaged repeatedly without discomfort or radiation exposure for the patient. Ultrasound is thus particularly valuable in follow-up of disease, differential diagnosis and detection of complications. Diagnostic and therapeutic interventions in patients with pathologic pleural and pulmonary findings can tolerably be performed under real-time ultrasound guidance. In this article, an updated overview is given presenting not only the benefits and indications, but also the limitations of pleural and pulmonary ultrasound.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus, Bad Mergentheim, Germany.
| | | | - Xin-Wu Cui
- Department of Internal Medicine 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Michael Hocke
- Department of Internal Medicine 2, Hospital Meiningen, Meiningen, Germany
| | - Tim O Hirche
- Department of Pulmonary Medicine, German Clinic for Diagnosics, Wiesbaden, Germany
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45
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Trovato GM, Sperandeo M. The resistible rise of B-line lung ultrasound artefacts. Respiration 2015; 89:175-6. [PMID: 25592165 DOI: 10.1159/000369037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Guglielmo M Trovato
- Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
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46
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Zompatori M, Ciccarese F, Fasano L. Overview of current lung imaging in acute respiratory distress syndrome. Eur Respir Rev 2014; 23:519-30. [DOI: 10.1183/09059180.00001314] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Imaging plays a key role in the diagnosis and follow-up of acute respiratory distress syndrome (ARDS). Chest radiography, bedside lung ultrasonography and computed tomography scans can provide useful information for the management of patients and detection of prognostic factors. However, imaging findings are not specific and several possible differential diagnoses should be taken into account. Herein we will review the role of radiological techniques in ARDS, highlight the plain radiological and computed tomography findings according to the pathological stage of the disease (exudative, inflammatory and fibroproliferative), and summarise the main points for the differential diagnosis with cardiogenic oedema, which is still challenging in the acute stage.
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47
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Soldati G, Smargiassi A, Inchingolo R, Sher S, Nenna R, Valente S, Inchingolo CD, Corbo GM. Lung ultrasonography may provide an indirect estimation of lung porosity and airspace geometry. Respiration 2014; 88:458-68. [PMID: 25376260 DOI: 10.1159/000368086] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Echographic vertical artifacts (B-lines) in chest ultrasonography have often been associated with pathological patterns. A scientifically sound explanation of these artifacts has not yet been proposed. OBJECTIVES The 'spongy' nature of the lung in its liquid and solid components and the changes that take place in peripheral airspace (PAS) geometry might be the key point to understanding these phenomena. METHODS Six excised right rabbit lungs were obtained. Each lung underwent direct ultrasound evaluation in two different conditions: at complete tissue elastic recoil volume and at pulmonary expansion volume achieved by applying a constant positive pressure of 12 cm H2O. Lung volumes and densities were reported in both conditions. Histological examination was performed on three naturally collapsed lungs and on three lungs under positive pressure inflation after having been fixed in formalin solution. RESULTS Mean volumes of naturally collapsed lungs and fixed expanded lungs were 11.2 ± 0.36 and 44.83 ± 3.03 ml, respectively. Mean densities were 0.622 ± 0.016 and 0.155 ± 0.007 g/ml, respectively. Ultrasound evaluation of collapsed lungs showed dense vertical artifacts and a 'white lung' pattern, while the evaluation of expanded lungs showed hyperechoic line and horizontal artifacts of reflection. Histological evaluation showed a different PAS geometry in collapsed lungs caused by alveolar size reduction and shape changes with unfolded and closed units modifying the peripheral porosity of the frothy nature of the lung. CONCLUSIONS Airspace geometry, frothy nature and porosity are the determinants of the different behavior of ultrasound interacting with the subpleural lung parenchyma. Chest ultrasound may thus be interpreted as an indirect 'estimator' of lung porosity.
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Affiliation(s)
- Gino Soldati
- Emergency Medicine Unit, Castelnuovo Garfagnana General Hospital, Lucca, Italy
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48
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Breen DP, Daneshvar C. Role of interventional pulmonology in the management of complicated parapneumonic pleural effusions and empyema. Respirology 2014; 19:970-8. [PMID: 25039299 DOI: 10.1111/resp.12339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/07/2014] [Accepted: 05/06/2014] [Indexed: 02/01/2023]
Abstract
Pleural infection is a major problem that affects 80,000 cases per year in the UK and USA. It is increasing in incidence, and in an ageing population, it presents a complex challenge that requires a combination of medical therapies and may lead to the need for surgery. This article focuses on the role of the interventional pulmonologist in the diagnosis and management of pleural infection. In particular, we examine the role of pleural ultrasound in diagnostics, thoracocentesis and real-time guided procedures, and the current management strategies, including the controversial role of medical thoracoscopy.
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Affiliation(s)
- David P Breen
- Respiratory Department, Galway University Hospitals, Galway, Ireland
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49
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Pesin J, Faingersh A, Waisman D, Landesberg A. Highly sensitive monitoring of chest wall dynamics and acoustics provides diverse valuable information for evaluating ventilation and diagnosing pneumothorax. J Appl Physiol (1985) 2014; 116:1632-40. [DOI: 10.1152/japplphysiol.00966.2013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Current practice of monitoring lung ventilation in neonatal intensive care units, utilizing endotracheal tube pressure and flow, end-tidal CO2, arterial O2 saturation from pulse oximetry, and hemodynamic indexes, fails to account for asymmetric pathologies and to allow for early detection of deteriorating ventilation. This study investigated the utility of bilateral measurements of chest wall dynamics and sounds, in providing early detection of changes in the mechanics and distribution of lung ventilation. Nine healthy New Zealand rabbits were ventilated at a constant pressure, while miniature accelerometers were attached to each side of the chest. Slowly progressing pneumothorax was induced by injecting 1 ml/min air into the pleural space on either side of the chest. The end of the experiment ( tPTX) was defined when arterial O2 saturation from pulse oximetry dropped <90% or when vigorous spontaneous breathing began, since it represents the time of clinical detection using common methods. Consistent and significant changes were observed in 15 of the chest dynamics parameters. The most meaningful temporal changes were noted for features extracted from subsonic dynamics (<10 Hz), e.g., tidal amplitude, energy, and autoregressive poles. Features from the high-frequency band (10–200 Hz), e.g., energy and entropy, exhibited smaller but significant changes. At 70% tPTX, identification of asymmetric ventilation was attained for all animals. Side identification of the pneumothorax was achieved at 50% tPTX, within a 95% confidence interval. Diagnosis was, on average, 34.1 ± 18.8 min before tPTX. In conclusion, bilateral monitoring of the chest dynamics and acoustics provide novel information that is sensitive to asymmetric changes in ventilation, enabling early detection and localization of pneumothorax.
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Affiliation(s)
- Jimy Pesin
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Anna Faingersh
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Dan Waisman
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Carmel Medical Center, and Faculty of Medicine, Technion, Haifa, Israel
| | - Amir Landesberg
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
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50
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Inchingolo R, Smargiassi A, Mormile F, Marra R, De Carolis S, Lanzone A, Valente S, Corbo GM. Look at the lung: can chest ultrasonography be useful in pregnancy? Multidiscip Respir Med 2014; 9:32. [PMID: 24936303 PMCID: PMC4059469 DOI: 10.1186/2049-6958-9-32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/20/2014] [Indexed: 01/28/2023] Open
Abstract
Background This study aimed to evaluate the clinical value of chest ultrasound (US) in the detection, diagnosis and follow-up of pathologic processes of both peripheral lung parenchyma and pleural space in pregnant women. Findings Pregnant women admitted to Obstetric Pathology Hospital Department for respiratory diseases were enrolled. Chest US examination was performed when there was a respiratory disease highly suggestive of pneumonia and/or pleural effusion and chest X-ray (CXR) should have been obtained. Three chest US patterns were identified: lung consolidation (LC), pleural effusion (PE) and focal sonographic interstitial syndromes (SIS). When chest US pathologic signs were reported, one or more subsequent chest US examinations were performed to follow-up the patient until their complete resolution. Sixteen inpatients underwent 54 chest US evaluations. We identified: 9 LCs, 6 PEs and 11 SISs. Total number of CXRs was 7 (10 females avoided X-rays exposure and one underwent 2 CXR evaluations on the advice of Gynecologist). Chest US follow-up, during and after therapy, showed complete resolution of echographic patterns previously described. Conclusions Chest US evaluation during pregnancy is a useful diagnostic tool to detect and monitor respiratory diseases, avoiding excessive X-rays exposure.
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Affiliation(s)
- Riccardo Inchingolo
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Andrea Smargiassi
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy.,Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Flaminio Mormile
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Roberta Marra
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Sara De Carolis
- Obstetric Pathology Department, University Hospital "A. Gemelli", Rome, Italy
| | - Antonio Lanzone
- Obstetric Pathology Department, University Hospital "A. Gemelli", Rome, Italy
| | - Salvatore Valente
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Giuseppe M Corbo
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
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