Air in the Pleural Cavity Enhances Detection of Pleural Abnormalities by CT Scan

Abstract

Detection of pleural abnormalities on CT scan is critical in diagnosis of pleural disease. CT scan detects minute parenchymal lung nodules, but often fails to detect similar-sized pleural nodularity. This is likely because the density of the visceral/parietal pleura and pleural fluid is similar. We hypothesize that an air-pleural interface enhances detection of pleural abnormalities. We describe six patients with pleural abnormalities that were not (or barely) detected on initial CT scan. However, pneumothorax (either ex vacuo or from a genuine air leak) after pleural fluid drainage permitted the visualization of small pleural abnormalities on CT scan, which would be amenable to imaging-guided biopsies. This case series provides proof-of-principle evidence that the sensitivity of CT scan detection of pleural abnormalities is dependent on adjacent tissue density and can be enhanced by intrapleural air. Future studies of the potential for artificial pneumothorax to improve the diagnosis of pleural disease are warranted.

Translational Nanotherapeutics Reprograms Immune Microenvironment in Malignant Pleural Effusion of Lung Adenocarcinoma

“…The diagnosis of MPE‐LA remains challenging because it involves invasive procedures. [ 15 ] In our practice, we combined ultrasound (US)‐guided cutting‐needle biopsy (CNB) and standard pleural biopsy (SPB) to improve diagnosis accuracy, convenience, and safety of the approach. [ 16 ] Figure 1B shows the diagnostic approach and the procedures undergone by the patients.…”

Diagnostic Value And Safety of Medical Thoracoscopy In The Pleural Effusion of Different Causes

“…Differentiating benign from malignant pleural effusions is critical for diagnosis establishment, management guidance, and prognosis judgement [10]. Over the past years, it was the primary methods that effusion examination, CPB, coupled with clinical history, blood biochemistry, imaging examination, are applied to distinguish benign and malignant pleural effusion, despite the low diagnostic yield.…”

“…Unlike the lung nodules, radiologic methods such as CT often fails to pick up early pleural abnormalities, given a similar density between the apposed pleura and adjacent pleural effusion [10]. Therefore, MT has been the optimal choice, owing to its direct visible access to the lesions.…”

Management of Malignant Pleural Effusions—What Is New

“…The traditional diagnostic approach involved employing (often multiple) invasive pleural procedures in many patients with suspected MPE. 16,17 Patients would undergo repeated (two to three in many cases) pleural fluid sampling for cytologic analyses, followed by "blind" percutaneous pleural biopsy and often diagnostic surgery (either videoassisted thoracoscopic surgery [VATS] or thoracotomy) which came with significant risks, complications such as morbidity, e.g., long-term neuralgia, pneumothorax, respiratory failure, and prolonged hospital stay. Improvements in cytological techniques and the increased availability of advanced imaging techniques now allow the clinician to establish the diagnosis using minimally invasive techniques such as image-guided percutaneous pleural biopsy, thus significantly reducing the need for more invasive surgical procedures.…”

“…4A, B). 17 This novel concept is being tested further in a pilot trial (ACTRN12615000337572) in which an air-pleura interface is deliberately created through a controlled introduction of air into the pleural space in patients with suspected MPE.…”