Accuracy of transthoracic ultrasound for the detection of pleural adhesions

Cassanelli, Nicola; Caroli, Guido; Dolci, Giampiero; Dell’Amore, Andrea; Luciano, Giulia; Bini, Alessandro; Stella, Franco

doi:10.1093/ejcts/ezs144

Cited by 60 publications

(49 citation statements)

References 14 publications

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“…Cassanelli et al [29] already showed that ultrasound is able to detect pleural adhesions. Future studies might investigate whether patients with more peripheral destruction in panlobular or paraseptal emphysema and adjacent pleural adhesions are at higher risk of developing pneumothorax than patients with a more centrilobular emphysema.…”

Section: Discussionmentioning

confidence: 99%

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

et al. 2017

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Background: Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax. Objective: To assess whether pleural adhesions on pretreatment high-resolution computed tomography (HRCT) scans are associated with pneumothorax occurrence after EBV treatment. Methods: HRCT scan analyses were performed on all patients who received EBV treatment in a randomized controlled trial. Three blinded readers scored adhesions by number and by measuring the longest axis of each pleural adhesion in the treated lung. The Pleural Adhesion Score (PAS) was calculated by adding 1 point for each small pleural lesion (<1 mm), 5 points for each medium-sized lesion (1-5 mm), and 10 points for each large lesion (>5 mm). Results: The HRCT scans of 64 treated patients were assessed, of whom 14 developed pneumothorax. Patients who developed pneumothorax had a higher median number of pleural adhesions, 2.7 (IQR 1.9-4) compared to 1.7 (1-2.7) adhesions in the group without pneumothorax (p < 0.01). The PAS in the group with pneumothorax was higher compared to that in the group without: 14.3 (12.4-24.1) versus 6.7 (3.7-11.2) (p < 0.01). A threshold PAS of ≥12 was associated with a higher risk of pneumothorax (OR 13.0, 95% CI 3.1-54.9). A score <12 did not rule out the occurrence of pneumothorax. Conclusion: A higher number of pleural adhesions on HRCT with a subsequent higher PAS in the treated lung is associated with a higher occurrence of pneumothorax after EBV treatment.

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Section: Discussionmentioning

confidence: 99%

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

et al. 2017

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“…If lung sliding is present, there are no pleural adhesions in the intended surgical site. If no lung sliding is present, adhesions should be suspected and the incision should be performed elsewhere [239]. Lung recruitment following positive end-expiratory pressure can be assessed with LUS [158, 178].…”

Section: Resultsmentioning

confidence: 99%

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

et al. 2014

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ObjectivesTo create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians.MethodsThis is a narrative review combined with a structured Medline literature search.ResultsUltrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size.ConclusionsUltrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits.Teaching Points• Ultrasonography is becoming essential in management of the upper and lower airways.• The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation.• Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax.• Point-of-care ultrasonography of the airways has a steep learning curve.• Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.

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“…Moreover, pleural-parenchymal adhesions are not easily predictable [10]. Although a recent study has used an ultrasound approach to predict the presence of adhesions before lung operations, directing the surgeon towards an open or video-assisted approach, the confirmation of partial or complete obliteration of the pleural space can only be obtained at the time of thoracotomy [11]. The lysis of pleural parenchymal adhesions with limited extension is generally performed with gentle blunt manual or instrumental dissection or by monopolar or bipolar electrocautery [12].…”

Section: Discussionmentioning

confidence: 99%

Impact of Transcollation technology in thoracic surgery: a retrospective study

Ibrahim

Menna

Maurizi

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: This is a retrospective study to evaluate the effectiveness of Transcollation technology (TT) in reducing blood loss and improving the postoperative outcome in patients with severe pleural-parenchymal adhesions who underwent major lung resection. METHODS:Between November 2010 and February 2012, TT was used to perform lysis of adhesions and dissection in 110 patients (TT Group) who underwent major lung resections via thoracotomy. Conventional electrocoagulation was used in 129 patients (EC Group). Operative time, daily drainage amount at 24, 48 and 72 h, pre-and postoperative haemoglobin levels, need for blood transfusion, intraand postoperative air leaks and duration of chest tube placement and hospital stay were analysed. RESULTS:No adverse events related to the TT system occurred, including reoperation for bleeding. The mean operating time was 95.2 ± 35.4 min in the TT Group versus 117.1 ± 73.4 min in the EC Group (P = 0.017). The mean postoperative haemoglobin level was 12.3 ± 3.9 g/dl versus the preoperative level of 13.8 ± 2.2 g/dl in the TT Group (P = 0.154) and 9.6 ± 2.8 vs 13.2 ± 2.1 g/dl in the EC Group (P = 0.001). Only 2 patients (1.8%) received postoperative blood transfusion in the TT Group vs 19 patients (14.7%) in the EC Group (P = 0.001). Intraoperative and postoperative (24 h) air leak rates were 4.7% (n = 5) and 2.8% (n = 3) in the TT Group vs 13.9% (n = 18) and 12.4% (n = 16) in the EC Group (P = 0.001), respectively. The mean duration of chest tube placement was shorter in the TT Group (4.7 ± 0.8 vs 6.8 ± 1.1 days, P = 0.013), as well as the mean hospital stay (5.3 ± 1.9 vs 7.5 ± 0.3 days, P = 0.007). CONCLUSIONS:The use of TT seems to reduce haemorrhage occurrence and postoperative hospital stay after major lung resection in patients with severe pleural-parenchymal adhesions.

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Accuracy of transthoracic ultrasound for the detection of pleural adhesions

Abstract: Transthoracic ultrasound is an effective method for predicting pleural adhesions before thoracic surgery in experienced hands. Its safety, feasibility and low cost make it a useful method for the planning of minimally invasive surgical interventions.

Cited by 60 publications

References 14 publications

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

Impact of Transcollation technology in thoracic surgery: a retrospective study

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