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The Respiratory System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The fiberoptic bronchoscope is an instrument utilized for visual examination of the bronchi through the procedure of bronchoscopy and may be used to obtain bronchial brushings and biopsies. Mediastinoscopy is the examination of the mediastinum and its lymph nodes, particularly in suspected malignancy. Use of an endoscope to inspect the larynx is laryngoscopy. Thoracoscopy denotes examination of the pleural cavity. Fluoroscopy is a type of radiographic technique that allows visualization of the thoracic contents In a dynamic manner and provides a range of views.
Lung cancer and mesothelioma
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
This is more invasive than obtaining fluid for cytology. It does, however, give a more reliable tissue diagnosis. A needle technique can usually be performed under local anaesthetic. Ultrasound or CT can be used to obtain better localization of pleural plaque for sampling. In difficult cases, an open biopsy at thoracoscopy or thoracotomy is necessary. Surgical biopsy has the advantage of yielding a larger specimen for histological analysis, drainage of pleural fluid and even simultaneous talc pleurodesis.
Innovative Approach to Minimally Invasive Resection of a Second Rib Aneurysmal Bone Cyst
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Minimally invasive approaches should be considered for small- to medium-sized benign or low-grade malignant lesions of the chest wall that do not require large margins of resection and have less risk of local recurrence. Although this does not preclude MICR for malignant tumors that require more radical resection [6], this may best be done in a clinical trial setting since long-term outcomes including recurrence have not yet been reported with this approach. It is critical to adhere to the principles of surgical oncology when resecting any chest wall tumor, taking care to ensure that adequate margins are obtained and to avoid contamination of normal tissue by malignant cells. Reconstruction of the chest wall is not always necessary when resection is limited and should be determined on an individual basis. Minimally invasive reconstruction of the chest wall via thoracoscopy is also feasible and has been described by other authors [7].
Catamenial pneumothorax, a commonly misdiagnosed thoracic condition: case report
Published in Acta Chirurgica Belgica, 2023
Laurie Stiennon, Vincent Tchana Sato, Jean-Paul Lavigne, Jean Olivier Defraigne
A 43-year-old woman presenting a right chest pain associated with an exertional dyspnea was admitted to our emergency department. She had no other complaints. She had menstruation at that time. She was a non-smoker and her only medication was a contraceptive pill. A chest-CT was realised and showed a right partial pneumothorax (Figure 1). The patient had a past medical history of several episodes of right-sided pneumothorax and had benefited from a thoracoscopy with pleural abrasion 5 years earlier. Our pneumologist decided to perform a pleuroscopy with talc pleurodesis. The pleuroscopy didn’t show any endometrial lesions on the pleural cavity, nor any emphysematous bulla. However, it demonstrated four holes in the tendinous part of the diaphragm with visualization of the hepatic dome. Therefore, the pneumologist decided not to perform the talc pleurodesis (Figure 2). The diagnosis of catamenial pneumothorax was made. A thoracoscopy was realised and confirmed the pleuroscopy findings. A direct closure of the holes was performed with X-shaped suture and non-resorbable stitches, a vicryl mesh was applied on the diaphragm. The chest tube was removed on postoperative day. There was no pneumothorax, nor pleural effusion on the chest radiography (Figure 3). The postoperative course was uneventful. At 6 weeks follow-up, the patient is in good clinical condition with no residual dyspnea, nor chest pain.
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients
Published in Expert Review of Respiratory Medicine, 2023
D N Addala, P Denniston, A Sundaralingam, N M Rahman
Pleural biopsies under direct vision using a fibre-optic camera (Figure 2b) to assess the macroscopic appearance of the pleura, diaphragm, and lung and guide biopsy targets remains the gold standard investigation for diagnosing unexplained exudative pleural effusions. Medical thoracoscopy (MT or local anesthetic thoracoscopy) is typically undertaken by pleural or respiratory physicians, with conscious sedation in a spontaneously breathing patient and usually occurs as a day case procedure. Surgical thoracoscopy (video-assisted thoracoscopic surgery, VATS) is conducted under general anesthetic and requires single lung ventilation, and thus requires a patient that is fit enough to survive these. Both techniques allow for highly effective diagnostic pleural sampling and inspection of the pleural space, however key differences arise in regard to the technical feasibility between the two, length of stay associated and the extent of therapeutic interventions that can be delivered contemporaneously.
Permanent indwelling catheter for the management of refractory malignant pericardial effusion
Published in European Clinical Respiratory Journal, 2022
Frederik Schultz Pustelnik, Christian B. Laursen, Arman Arshad, Ahmed Aziz
A control TTE 14 days after the PCC showed recurrence of very large MPcE with swinging heart, compression of the right ventricle and dilated vena cava. Due to recurrent MPcE, the patient was treated with pericardiectomy and establishment of a pericardial window (PW). The procedure was performed thoracoscopic. Nine days after the PW was established, there was no MPcE on TTE, and the treatment with immunotherapy was initiated. The patient was admitted at the Department of Cardiology 18 days after the PW due to shortness of breath. Acute TTE revealed recurrence of MPcE with compression of the right ventricle. An acute PCC with removal of 500 mL fluid was performed. The catheter was left in the pericardial sac. The case study was discussed at a multidisciplinary team conference with attendance of cardiologists and pulmonologists from the lung cancer unit. Due to recurrent MPcE predominantly over the right ventricle, there was an increased risk of complications during repeated PCC and lack of efficiency of the PW. A decision to attempt to place a PiC (PleurX) in the pericardial sac for palliation and possible PCD was made. The patient was informed about the experimental nature of the procedure and a lack of other effective treatment methods. He accepted the PiC treatment.