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Diseases of the pleura
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
A pleural effusion containing malignant cells is called a malignant pleural effusion [20–24]. These effusions result from the cumulative effects of increased capillary permeability secondary to tumor implants on pleural surfaces (increased fluid production) and impaired fluid resorption due to tumor invasion of the pleuro-mediastinal lymphatics (lymphatic obstruction; Table 13.9). Direct invasion of the parietal pleura by lung cancer or less commonly by primary pleural tumors is yet another mechanism that can increase fluid production. Through a combination of each of these mechanisms, several liters of fluid can accumulate in the pleural space, causing lung (ipsilateral and contralateral) as well as mediastinal (vena cava) compression. Ultimately, these compressions will cause loss of pulmonary function and decrease in cardiac output.
Cardiovascular cases
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
Hannah Adams, Sarah Hancox, Cristina Ruscanu, David C Howlett
Sudden onset shortness of breath with a background of malignancy suggests:Pulmonary embolus.Myocardial infarction with acute heart failure.Malignant pleural effusion.Pneumonia secondary to chemotherapy (immunosuppression).Pneumothorax.Rib fracture.Metastases (lung or bone).
Small Cell Lung Carcinoma
Published in Dongyou Liu, Tumors and Cancers, 2017
Clinical symptoms of lung cancer range from coughing (smoker’s cough), dyspnea (bronchial stenosis, malignant pleural effusion, or pericardial fluid buildup), hemoptysis (small tinges of blood in expectorate), respiratory tract infections (due to a bronchial obstruction), chest pain (due to direct involvement of the chest wall or pleura), loss of appetite, weight loss, to fatigue.
The diagnostic value of CEA for lung cancer-related malignant pleural effusion in China: a meta-analysis
Published in Expert Review of Respiratory Medicine, 2022
Chen Cheng, Yongguo Yang, Wei Yang, Daomeng Wang, Chen Yao
Currently, closed pleural biopsy and thoracentesis have become routine operations to clarify the nature of pleural effusion. The detection of cancerous cells in the pleural effusion is the gold standard for the diagnosis of malignant pleural effusion, but only when the pleura is invaded or metastasized or the malignant tumor tissue falls off directly into the pleural effusion could result in a clear positive result. These methods have high specificity, but the positive rate is low, which has been reported in the literature that the positive rate of a single test in the pleural fluid is 58% [6]. Also, there is a false negative rate in the examination of exfoliated cells, and its sensitivity is 60% [7]. The diagnosis of mesothelioma has a positive rate of less than 20% [1], and the operation of thoracentesis is risky and traumatic. Although the operation is ultrasound-guided, there is a 1% chance of pneumothorax and multiple complications may occur, such as pain, shortness of breath, cough, and hematoma [8]. In recent years, the noninvasive differential diagnosis of benign and malignant pleural effusion has made progress. Carcinoembryonic antigen (CEA), as a broad-spectrum tumor marker, tends to accumulate in the pleural cavity when the pleura is invaded by malignant tumors, which is a good tumor marker for MPE [9].
Budget-impact analysis for pleuroscopy in the diagnosis of undifferentiated pleural effusion
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Inderdeep Dhaliwal, Daniel Gillett, Emma Train, Kayvan Amjadi, Michael Mitchell, Ana Johnson
In terms of strengths, this study compared the utilization of two equivalent procedures, from the hospital system perspective. There was literature review to support efficacy between the procedures, as well as previous studies surrounding utilization for patients suffering from malignant pleural effusion. Both VATS-P and MP data were collected as per the OCCI standard, which is a recognized and validated method to determine healthcare utilization.39 The BIA model was built using published data with a robust utilization database (HCUP-NIS) and cost data from OCCI. In order to avoid over-estimating cost savings, a scenario analysis including estimated ongoing IPC costs was performed. This analysis may serve to support physicians and hospitals providing VATS-P to consider a shift of practice toward MP and IPC for the majority of undifferentiated pleural effusion.
Clinical and dosimetric evaluation of recurrent breast cancer patients treated with hyperthermia and radiation
Published in International Journal of Hyperthermia, 2019
Sharvari Dharmaiah, Johnathan Zeng, Vinay S. Rao, Ouyang Zi, Tianjun Ma, Kevin Yu, Heeruk Bhatt, Chirag Shah, Andrew Godley, Ping Xia, Jennifer S. Yu
Acute toxicities included pain, erythema, edema, blisters, ulcerations, nausea, and scarring or fibrosis. The most frequent acute side effects were grade 1–2 pain and erythema (Table 3). Late toxicities included grade 1–2 hyperpigmentation or tanning, lymphedema, scarring or fibrosis, desquamation, pain and telangiectasias. One patient developed pulmonary fibrosis resulting in mild dyspnea on exertion. She received right chest wall re-irradiation with opposed tangents. Three patients developed shortness of breath in the setting of malignant pleural effusion. Six patients had ulcerations, half of whom presented with ulcerations at the time of presentation due to tumor growth. The 3 patients who developed skin ulceration after treatment healed with conservative measures. For these patients, the median time to ulcer development after completion of radiation was 69 days (range 45–217 days). All of these ulcers developed within the hyperthermia and radiation field.