Pulmonary Tuberculosis
Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies in Clinical Tuberculosis, 2020
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
Lung cancer and mesothelioma
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
Lung cancer spreads circumferentially and longitudinally along the bronchus of origin, eventually leading to bronchial occlusion, which causes lobar or segmental pulmonary collapse owing to the resorption of air distal to the tumour. Stasis of pulmonary secretions in turn leads to secondary infection manifesting as pneumonia and occasionally lung abscess and empyema. Proximally the tumour may extend to the carina and trachea while distally it may reach the visceral pleura from where it may invade the chest wall, interlobar fissures or pleural space, resulting in a blood-stained exudative pleural effusion. A pneumothorax may result from a tumour that breaches the visceral pleura and allows a direct connection between the pleural space and the bronchial tree, i.e. a bronchopleural fistula. Mediastinal structures such as the oesophagus, pericardium, heart and great vessels, and occasionally the vertebral bodies and diaphragm, may be invaded. The tumour frequently involves the regional lymphatics, spreading to ipsilateral peribronchial and hilar nodes, followed by subcarinal, contralateral hilar, paratracheal and supraclavicular nodes (Figure 7.1). Lung cancer has a propensity to disseminate widely via the bloodstream and can virtually involve any site. There is an unusual and unexplained involvement of the adrenal glands in a high proportion of cases. Other common sites include the liver, skeleton, brain (especially SCLC), skin and contralateral lung.
An Unsupervised Parametric MixtureModel for Automatic Three-DimensionalLung Segmentation
Ayman El-Baz, Jasjit S. Suri in Lung Imaging and CADx, 2019
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].
Malignant mesothelioma of the peritoneum mimicking primary peritonitis carcinomatosis
Published in Journal of Obstetrics and Gynaecology, 2023
Saliha Sağnıç, Özer Birge, Anıl Alpsoy, Selen Doğan, Hasan Aykut Tuncer, Elif Peştereli, Tayup Şimşek
Mesothelioma is a primary tumour originating mostly from mesothelial cells lining the pleura, and more rarely from peritoneum and pericardium (Sterman et al.1999). Peritoneal malignant mesotheliomas are aggressive tumours (Alexander and Burke 2016). They constitute 15–33% of all malignant mesothelioma cases (Ohya et al.2019). Patients with peritoneal malignant mesothelioma present with peritoneal thickening and irregularity, peritoneal masses, diffuse ascites, lymph node enlargement and/or adnexal masses, and imaging reveals mesenteric tissue irregularity and metastasis to distant or adjacent organs. The most common clinical findings are ascites, nausea, vomiting, abdominal pain, weight loss, fever, diarrhoea, anorexia, early satiety and fatigue (Liang et al.2016).
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.
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