Prognostic Value of Computed Tomography in Empyema: A Multicenter Retrospective Cohort Study

Effectiveness of Immediate Video-Assisted Thoracoscopic Surgery for Empyema: A Multicentre, Retrospective Cohort Study

“…The kappa statistics of the CT interpretations between a radiologist and a respiratory physician were as follows: pleural thickness, 42% (95% confidence interval [CI], 36 to 48%); loculation, 87% (95% CI, 77 to 98%); interlobar pleural effusion, 85% (95% CI, 74 to 97%); and lung abscess, 88% (95% CI, 76 to 99%). The details are described elsewhere [21]. Because criteria for determining the empyema stage have not been established, stage ≥II was defined when the following conditions were met: macroscopically purulent, pH of pleural fluid <7.2, glucose level in pleural fluid <60 mg/dL, lactate dehydrogenase level >1,000 IU/L, positive Gram staining or culture for bacteria, and pleural thickness or loculation on chest CT [16].…”

Improving Prognostication in Empyema: Is Computed Tomography the Answer?

“…Nonetheless, the aforementioned limitations do not detract from the importance of the work conducted by Shiroshita and colleagues ( 10 ). Although ultrasound has become the default early imaging strategy for empyema, because of its point-of-care access and utility in targeted pleural intervention, the use of CT scanning in empyema remains heterogeneously deployed.…”

“…To this end, Shiroshita and colleagues (pp. 807–814 ) report their findings on the prognostic value of CT in empyema in this issue of AnnalsATS ( 10 ). The authors conducted a multicenter retrospective cohort study across six centers in Japan, assessing a number of CT findings in patients with confirmed empyema and the difference in 90-day mortality and the duration of inpatient hospital stay.…”

Man versus Machine in Pleural Diagnostics: Does Artificial Intelligence Provide the Solution?

“…Within pleural disease, integration of clinical presentation, pleural fluid parameters, and imaging has been the default for many years in achieving sometimes complex diagnoses. CT imaging is becoming an increasingly common investigation in pleural diagnostics ( 14 ), providing information on parenchymal and extrathoracic pathology, and, as such, the integration of CT findings would be a key future direction. Finally, the latest evidence in pleural diagnostics rightly serves to move beyond overarching disease classification (e.g., malignant vs. nonmalignant disease), focusing on more sophisticated diagnostics, such as molecular cancer markers to guide immune-based treatment ( 15 ) and biopsy to improve microbiological culture yield, to tailor treatment ( 16 ).…”