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The Extra-Pleural and Pleural Spaces, including Plombages, Pleural Tumours and the Effects of Asbestos.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Flower (1999) pointed out that intralobar masses in the fissures are usually secondary deposits or mesotheliomas. A fibrothorax may be mimicked by a mesothelioma or adenocarcinoma, and such thickening is usually malignant if 1cm or more thick, is nodular or is circumferential and extends to the mediastinal aspect of the chest. Adenocarcinomas may produce a desmoplastic response to small 'nests' of malignant cells,
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Fibrothorax is a benign entity that can occur as a sequelae to inflammation, tuberculosis or haemothorax. In this condition, pleural thickening is smooth, it may be calcified and does not usually involve the mediastinal surface.
Thorax
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
Are the following statements regarding mesothelioma true or false? It is always malignant.It may be assessed with Butchart staging.Pleural plaques are present in 90%.It usually destroys the underlying rib.It may simulate fibrothorax.
Medical thoracoscopy in the diagnosis of pleural disease: a guide for the clinician
Published in Expert Review of Respiratory Medicine, 2020
Faisal Shaikh, Robert J. Lentz, David Feller-Kopman, Fabien Maldonado
Another tool that has been developed to help circumvent the shortcomings of flexi-rigid thoracoscopy is the diathermic cutting knife. Sasada et al. first described this technique in 2006 in their single-center prospective study of 20 patients. The insulated-tip (IT) diathermic knife (Olympus, Tokyo, Japan) was originally borrowed from gastric endoscopy and was designed to minimize the risk of intestinal wall perforation during biopsy. Similar to the technique in gastric endoscopy, this approach involves a subpleural saline injection mixed with 0.5% lidocaine and 0.005% epinephrine at the site of interest resulting in an elevation of the pleural surface. A puncture is then made with coagulation forceps and the IT knife is used to incise the pleura in a circular fashion with a combination of cutting and coagulating at a current of 30–40 W. The isolated segments are then removed with forceps. They reported a diagnostic value of 85% for IT knife compared to 60% for forceps biopsy with 8 out of 20 patients having smooth, thickened pleura [106]. More studies are needed to further validate the role of IT in pleural biopsy. Wang et aet al. reported on a slightly different, scissors-type monopolar electrosurgical knife with 30 W output following a similar protocol of saline and lidocaine administration to elevate the lesion. They were successful in obtaining diagnostic biopsies in this series of two patients with fibrothorax as well as performing successful adhesiolysis in one case [144].
Tuberculous pleural effusion: diagnosis & management
Published in Expert Review of Respiratory Medicine, 2019
Leila Antonangelo, Caroline S. Faria, Roberta K. Sales
At the end of anti-TB treatment, approximately 25% of patients with PT have residual pleural thickening (1cm), which decreases with time and has no impact on pulmonary function [105,106] (Figure 4). Applying the strict definition of fibrothorax, i.e., a pleural membrane thick of at least 5 mm that extends through large portions of the hemithorax is more realistic and widely accepted [13]. A study by de Pablo et al. showed that residual pleural thickening correlated significantly with lower PF pH levels and higher concentrations of lysozyme and TNF-α [107]. Similarly, the decline in proinflammatory cytokine levels after two weeks of anti-TB chemotherapy could predict the degree of pleural thickening [108]. These parameters, indicators of the intensity and persistence of pleural inflammation, may allow the early identification of individuals more likely to evolve with residual pleural fibrosis and, therefore, a more invasive therapeutic approach should be instituted; however, more studies in this area need to be conducted.
Insight into diagnosis of pleural tuberculosis with special focus on nucleic acid amplification tests
Published in Expert Review of Respiratory Medicine, 2022
Aishwarya Soni, Astha Guliani, Kiran Nehra, Promod K. Mehta
TPE patients may present pleuritic chest pain followed by cough (mostly nonproductive), fever, weight loss, night sweats and dyspnea [9,11]. These symptoms along with corroboration of pleural effusion are suggestive of pleural TB [11]. A retrospective study conducted by Zhao et al. [12] on 232 TPE patients showed fever (76.3%), cough (75.3%), respiratory distress (66.4%), chest pain (60.9%), night sweats (37.5%) and emaciation (13.2%). Notably, neutrophil-dominant effusion was observed in 10.9% TPE patients, which revealed higher fever (51.5 vs. 32.4%) and higher decortication rates (15.2 vs. 4.1%) than lymphocyte-predominant TPE [12], although neutrophil-predominant TPE had lower chest distress (48.5 vs. 68.6%) and lower positive rates of PTB (42.8 vs. 60.8%) than lymphocyte-predominant TPE. TB empyema occurs owing to prolonged active infection of pleura with the influx of neutrophils and consequent development of purulent pleural fluid [5], which often involves surgical intervention. TB empyema occurs in three stages: i) pre-empyema exudative phase (viscous and sterile effusion), ii) fibrinopurulent phase (thick purulent fluid) and iii) organizing phase (granulation tissue formation) [5]. A retrospective cohort study [13] documented that pleural TB with empyema was observed in 9% of total 474 TB cases (all were culture-positive), wherein pleuritic chest pain was noted in 41% cases. Markedly, pleural fibrosis or fibrothorax is important complication of TPE that leads to chronic chest pain and dyspnea [14]. Furthermore, empyema necessitans is a rare condition caused by TB empyema, wherein infection extends through parietal pleura into chest wall and drains onto skin through fistula [5].