Pleural interventions: less is more?

Hassan, Maged; Munavvar, Mohammed; Corcoran, John

doi:10.1183/2312508x.10023319

Cited by 6 publications

(3 citation statements)

References 44 publications

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“…In conditions known to cause diffuse pleural disease, typically tuberculosis, they carry a high yield amongst skilled operators. This has been quoted as high as 90% in the literature [56,57]. Where the technique falls short however (sens < 60%), is with the diagnosis of malignant pleural disease, which has a patchier distribution and tends to favour regions not easily accessible percutaneously (posteromedial and diaphragmatic regions).…”

Section: Closed Reverse-bevel Needles (Abrams or Cope)mentioning

confidence: 99%

Diagnostics in Pleural Disease

2020

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Pleural disease diagnostics represent a sprawling topic that has enjoyed a renaissance in recent years from humble beginnings. Whilst pleural patients are heterogeneous as a population and in the aetiology of the disease with which they present, we provide an overview of the typical diagnostic approach. Pleural fluid analysis is the cornerstone of the diagnostic pathway; however, it has many shortcomings. Strong cases have been made for more invasive upfront investigations, including image-guided biopsies or local anaesthetic thoracoscopy, in selected populations. Imaging can guide the diagnostic process as well as act as a vehicle to facilitate therapies, and this is never truer than with the recent advances in thoracic ultrasound.

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Section: Closed Reverse-bevel Needles (Abrams or Cope)mentioning

confidence: 99%

Diagnostics in Pleural Disease

2020

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“…[15] Nonetheless, CT is not always available, and is usually the purview of radiologists, whereas US is safer (being radiation-free), and allows the user to perform procedures entirely in real-time. [23] Transthoracic US, at its most basic, requires a 2-dimensional real-time visualization of a cutting needle into the pleural tissue. This is usually performed in-plane with the US probe held horizontally and the cutting needle introduced at a 45° angle, producing a long axis image on the screen [Fig.…”

Section: Ultrasound Guidancementioning

confidence: 99%

“…It has been proposed that when there is pleural thickening/nodularity in the absence of pleural thickening, thoracoscopy should be considered if lung sliding is still seen on US images (implying that pneumothorax induction would be successful), and that PET-CT is a useful tool for identifying a pleural target in this setting. [23] In all, 4-6 separate pleural biopsy specimens are sufficient for histology and microbiologic testing, but a greater number of specimens may be needed for molecular profiling of malignancy. [39] Kirsch et al [40] reported that the diagnostic sensitivity for tuberculous effusion approached 100% at 6 samples.…”

Section: Integrating Ultrasound-guided Closed Pleural Biopsy Into Dia...mentioning

confidence: 99%

Ultrasound-guided pleural biopsy

Boy

2022

Eurasian J Pulmonol

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A pleural exudate that remains undiagnosed after a combined clinical assessment, thoracentesis, and imaging requires a pleural biopsy for a definitive diagnosis. Thoracoscopy is often the first method of choice to obtain tissue as it offers greater sensitivity and there is a perception of less risk. However, with imaging guidance, closed pleural biopsy is a safe, affordable, and effective alternative to diagnose all forms of pleural disease. Ultrasound (US) has several benefits when compared with computed tomography for image-guided biopsy, as it is widely available, can be performed bedside, and does not expose the patient to radiation. If performed in optimal conditions, a transthoracic USguided closed pleural biopsy can yield results comparable to those of thoracoscopy and a marked reduction in the complication rate versus blind biopsy. Abrams and Tru-Cut needles are the most widely used for a closed pleural biopsy. Either may be used with real-time image guidance or with a free-hand image-assisted technique to harvest up to 6 separate tissue samples. The needle choice will depend on the morphology of the lesion observed on imaging. The Tru-Cut is generally preferred for mass lesions of the pleura or pleura that is >20 mm in thickness, and the Abrams for pleural thickening of <20 mm or radiologically normal pleura. A transthoracic US may be used to detect, rule out, and prevent complications, such as bleeding, solid organ injury, or pneumothorax. The ability to perform thoracic US is a necessary skill in current respiratory practice, and US-guided closed pleural biopsy has a critical role in diagnosis.

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Enfoque diagnóstico en el paciente con derrame pleural

Oyonarte W.

2024

Revista Médica Clínica Las Condes

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Pleural interventions: less is more?

Cited by 6 publications

References 44 publications

Diagnostics in Pleural Disease

Diagnostics in Pleural Disease

Ultrasound-guided pleural biopsy

Enfoque diagnóstico en el paciente con derrame pleural

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