What is the significance of non‐specific pleuritis? A trick question

Janssen, J.; Maldonado, Fabien; Metintaş, Muzaffer

doi:10.1111/crj.12940

Cited by 28 publications

(22 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Review of the literature shows that lung biopsies may reveal non-specific pleuritis in up to 30% of cases. 20 However, 75% of the patients in our cohort had pleuritis, which is higher than expected, and may indicate a secondary reactive process, possibly to the airborne hazards to which these patients were exposed.…”

Section: Discussioncontrasting

confidence: 52%

Non‐necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia

et al. 2020

View full text Add to dashboard Cite

Aims Reports of respiratory illnesses among soldiers returning from Southwest Asia have been described. During deployment to Southwest Asia, soldiers are exposed to various respiratory hazards, including dust storms, smoke from burn pits and industrial air pollutants. A few studies have reported increased rates of constrictive bronchiolitis and asthma in these patients. We sought to expand upon the pathological findings in this cohort. Methods and results Lung biopsies from veterans of Southwest Asia were identified and re‐reviewed. All patients had undergone pulmonary function tests and chest high‐resolution CT imaging with no significant findings. Overall, 59 patients with a history of inhalational exposure to at least one of the following were identified: smoke from burn pit, dust storm and sulphur plant fire. Samples included video‐assisted thoracoscopic lung biopsies (57 of 59, 96.6%) and cryobiopsies (two of 59, 3.4%). Patients were predominantly male (54 of 59, 91.5%) with an age range of 24–55 years (mean and median = 35). Non‐necrotising, poorly formed granulomas were identified in 22 cases (22 of 59, 37.2%). The granulomas were mainly bronchiolocentric and were associated with chronic lymphoplasmacytic bronchiolitis, similar to hypersensitivity pneumonitis (HP). Pleural reaction in the form of focal chronic lymphocytic pleuritis and/or focal pleural adhesions were seen in 43 of 57 (75.4%) biopsies. Conclusions To our knowledge, this is the first study to report pleural reaction as well as features of HP in this population, suggesting that pleural reaction and HP may be part of the spectrum of Southwest Asia deployment‐related lung diseases.

show abstract

Section: Discussioncontrasting

confidence: 52%

Non‐necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In Southeast Asia, reported rates of non-specific pleuritis range from 12.0% 22 to 21.6%. 23 Although long-term follow-up on these cases did not frequently reveal a diagnosis of mesothelioma, 20 it is prudent to consider the possibility that the low prevalence of mesothelioma in Southeast Asia may be partly contributed by shallow biopsies leading to inconclusive or alternative diagnoses. Further research could look into the value of cryobiopsy in non-specific pleuritis.…”

Section: Discussionmentioning

confidence: 98%

“…While sensitivity and specificity of flexi-rigid pleuroscopy using conventional forceps in undiagnosed exudative pleural effusion is high, 5 increased false-negative results are seen in cases of thickened pleura. 19,20 Some factors that contribute to this include inadequate depth of biopsy sample 20 and the lack of mechanical power of the conventional forceps and a small cup size. 4,5 Cryobiopsy poses a potential solution to this problem, having been shown to be non-inferior to conventional forceps in the diagnosis of malignant mesothelioma.…”

Section: Discussionmentioning

confidence: 99%

Cryobiopsy In Flexi-Rigid Pleuroscopy in a Region with Low Mesothelioma Prevalence

Nyanti¹

2020

EMJ Respir

View full text Add to dashboard Cite

Background: The use of conventional flexible forceps during flex-rigid pleuroscopy can be challenging when sampling hard and thickened pleura. Pleuroscopic cryobiopsy is an emerging field, with various early studies demonstrating good yield and minimal complications. Objectives: To review the authors’ early experience of pleuroscopic cryobiopsy in their centre and highlight its utility in the diagnosis of mesothelioma. Method: Six cases of undiagnosed pleural effusion that underwent pleuroscopic cryobiopsy via flexi-rigid pleuroscopy between July 2017 and June 2019 were retrospectively analysed. Results: The cohort had a median age of 59 years, consisting of two females and four males with a median age of 57 years. Mean (aggregate) tissue sample diameter was 9.2±1.9 mm. Cryobiopsy established a definitive diagnosis in all six cases: one case of malignant mesothelioma, one pleural tuberculosis, two small cell carcinomas, and two adenocarcinomas. Immunohistochemical staining was performed in all five of the malignant samples (100%). There were no major complications reported. Conclusions: Based on the case series, pleuroscopic cryobiopsy is a feasible adjunct to conventional forceps biopsy, a safe procedure in the authors’ setting, gives high diagnostic yield, and enables differentiation between the different causes of exudative pleural effusion. A large, prospective study is required to validate this retrospective series.

show abstract

“…Follow-up of 12 months was considered sufficient to establish a malignant diagnosis, as per previous publications. 10…”

Section: Methodsmentioning

confidence: 99%

Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

et al. 2020

View full text Add to dashboard Cite

IntroductionCurrent guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and, at times, providing a therapeutic procedure. A wealth of research has been published since the guidelines suggesting that results and outcomes from an aspiration may not always provide sufficient information to guide management. It is important to establish the validity of these findings in a ‘real world’ population.MethodsA retrospective analysis was conducted of all patients who underwent pleural fluid (PF) sampling, in a single centre, over 3 years to determine the utility of the initial aspiration.ResultsA diagnosis of MPE was confirmed in 230/998 (23%) cases, a further 95/998 (9.5%) were presumed to represent MPE. Transudative biochemistry was found in 3% of cases of confirmed MPE. Positive PF cytology was only sufficient to guide management in 45/140 (32%) cases. Evidence of pleural thickening on CT was associated with both negative cytology (χ2 1df=26.27, p<0.001) and insufficient samples (χ2 1df=10.39, p=0.001). In NEL 44.4% of patients did not require further procedures after pleurodesis compared with 72.7% of those with expansile lung (χ2 1df=5.49, p=0.019). In patients who required a combined diagnostic and therapeutic aspiration 106/113 (93.8%) required further pleural procedures.ConclusionsAn initial pleural aspiration does not achieve either definitive diagnosis or therapy in the majority of patients. A new pathway prioritising symptom management while reducing procedures should be considered.

show abstract

What is the significance of non‐specific pleuritis? A trick question

Cited by 28 publications

References 16 publications

Non‐necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia

Non‐necrotizing granulomatous pneumonitis and chronic pleuritis in soldiers deployed to Southwest Asia

Cryobiopsy In Flexi-Rigid Pleuroscopy in a Region with Low Mesothelioma Prevalence

Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

Contact Info

Product

Resources

About