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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
Once the pleura has become involved, a pleural effusion is likely to develop, especially if there is venous or lymphatic obstruction to the underlying lung. However pleural effusions are not always due to tumours per se, and may arise as a result of secondary infection, infarction, pleural irritation or lymphatic obstruction. Sometimes little or no fluid is formed, and a 'dry pleurisy' results. Only a small amount of fluid is necessary for diagnostic aspiration to be carried out, and with only a few ml a small sample is easily obtained under ultrasound control (inexpiration) for cytology. This only takes a few moments, and in the author's view such sampling should be mandatory if fluid is present as it saves much time and effort, because if positive the patient is clearly inoperable. Blood staining of the fluid is itself suggestive of malignant involvement.
Pulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Charles S. Dela Cruz, Barbara Seaworth, Graham Bothamley
Pleural effusions are related to a primary focus close to the pleura, such that the inflammatory response causes fluid to accumulate within the pleural space. As such, the bacterial load is low (below the limit of 104/mL, at which point bacilli can be seen under the microscope18) and cultures for TB are rarely positive.19 Blind pleural biopsies can increase the likelihood of making the diagnosis from 60% to 90%.20,21 Video-assisted thoracoscopy may show a characteristic appearance of granulomas, if seeding of TB has occurred, and biopsies will then confirm the diagnosis by mycobacterial culture.22 In many cases, pleural effusions may resolve spontaneously, but infectious post-primary TB is then likely to occur within the next 5 years if no treatment is given.23,24
An Unsupervised Parametric MixtureModel for Automatic Three-DimensionalLung Segmentation
Published in Ayman El-Baz, Jasjit S. Suri, Lung Imaging and CADx, 2019
Mohammed Ghazal, Samr Ali, Mohanad AlKhodari, Ayman El-Baz
Figure 13.3 shows a cross-sectional view for the lungs. Each lung is covered with glistening visceral pleura, which has a translucent nature. This pleura looks pink, and it may accumulate black pigment due to age because of the exposure to environment particulates [5]. The pleura that covers each lung is a membrane consisting of two main layers: the visceral pleura and the parietal pleura. The visceral pleura extends into the lung fissures and forms invaginations into both lungs, while the parietal pleura connects the diaphragm and the mediastinum by the thoracic wall. The main function of the lung pleura is to reduce the friction between lung layers during the breathing process, to maintain the position of the lungs within the chest wall [3], and to produce the pulmonary ligament that holds the lungs over the diaphragm [6].
Optimization of pleural multisite anesthetic technique during CT-guide microwave ablation of peripheral lung malignancy for improving treatment tolerance
Published in International Journal of Hyperthermia, 2022
Hao Hu, Fulei Gao, Jinhe Guo, Gaojun Teng, Zhi Wang, Bo Zhai, Rong Liu, Jiachang Chi
Percutaneous thermal ablation of lung tumors adjacent to the pleura usually causes intolerable pain during the procedure. The pain is associated with thermal or polymodal nociceptors receptors in the parietal pleura and phrenic pleura, which are distributed and supplied segmental by intercostal nerve branches. When the pleura is stimulated, the skin areas where these nerves are distributed can cause pain in the associated area, such as chest, abdomen pain, neck and shoulder pain. Intolerable pain in the muscles and viscera occurs frequently and poses a significant challenge in clinical practice. Our study demonstrates that subpleural multisite anesthesia based on the area of thermal radiation for peripheral lung malignancy MWA resulted in a substantial reduction in the incidence of moderate or severe pain. In addition to the reduced incidence of moderate or severe pain, there was no statistically significant difference in the success rate between the two techniques. Our data suggest that different methods of preoperative subpleural anesthesia are important factors in the development of moderate or severe pain.
Applications of cryobiopsy in airway, pleural, and parenchymal disease
Published in Expert Review of Respiratory Medicine, 2022
Andrew DeMaio, Jeffrey Thiboutot, Lonny Yarmus
A recent meta-analysis revealed a similar diagnostic yield of pleural cryobiopsy and flexible forceps biopsy (96.5% vs 93.1%) with an inverse variance-weighted OR of 1.61 (95% CI: 0.71–3.66) and a heterogeneity index (I2) of 16% [110]. However, this study did not compare cryobiopsy to rigid forceps biopsy, which provides the largest tissue specimens in several prospective studies [105,111]. There are a few lessons to emphasize. First, thoracoscopy with either flexible forceps, cryobiopsy or rigid forceps provides an adequate diagnostic test with yields reported to be greater than 90% in most studies. Occasionally, fibrotic pleura may be encountered which is difficult to biopsy, especially with mesothelioma. In this case, additional biopsy tools should be considered including rigid forceps, or a flexible cryoprobe if a semi-rigid thoracoscope is used. Further multi-center prospective studies are needed to prove superiority of one technique.
Robot-assisted nephroureterectomy for upper tract urothelial carcinoma—feasibility and complications: a single center experience
Published in Scandinavian Journal of Urology, 2022
F. Liedberg, J. Abrahamsson, J. Bobjer, S. Gudjonsson, A. Löfgren, M. Nyberg, A. Sörenby
Peri-operative data are shown in Table 2. No patient had a complication with a Clavien-Dindo grade higher than three, and only one grade three complication was observed in an 85-years old female patient with a BMI of 19 who developed a post-operative pneumothorax that was successfully treated with a thoracic drain. The pneumothorax was considered an anaesthesiologic complication related to ventilation and not a surgical incision into the pleura. Of the grade 2 complications (n = 39), infection requiring antibiotic treatment was most common, followed by blood transfusion (28 and 5 patients, respectively). Estimated blood loss was 50 ml (IQR = inter quartile range 20–100 ml). The median hospital stay was 6 days (IQR 5–7 days). Twelve patients were re-admitted to the hospital within 90 days, because of urinary tract infection (n = 7), haematuria (n = 1), hematoma (n = 1), suspected cerebral insult (n = 1), atrial flutter (n = 1), and psoriasis rash (n = 1).