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AIM: The comparison between chest x-ray (CXR) and computed tomography (CT) images is commonly required in clinical practice to assess the evolution of chest pathological manifestations. Intrinsic differences between the two techniques, however, limit reader confidence in such a comparison. CT average intensity projection (AIP) reconstruction allows obtaining "synthetic" CXR (s-CXR) images, which are thought to have the potential to increase the accuracy of comparison between CXR and CT imaging. We aim at assessing the diagnostic performance of s-CXR imaging in detecting common pleuro-parenchymal abnormalities. MATERIALS AND METHODS: 142 patients who underwent chest CT examination and CXR within 24 hours were enrolled. CT was the standard of reference. Both conventional CXR (c-CXR) and s-CXR images were retrospectively reviewed for the presence of consolidation, nodule/mass, linear opacities, reticular opacities, and pleural effusion by 3 readers in two separate sessions. Sensitivity, specificity, accuracy and their 95% confidence interval were calculated for each reader and setting and tested by McNemar test. Inter-observer agreement was tested by Cohen's K test and its 95%CI. RESULTS: Overall, s-CXR sensitivity ranged 45-67% for consolidation, 12-28% for nodule/mass, 17-33% for linear opacities, 2-61% for reticular opacities, and 33-58% for pleural effusion; specificity 65-83%, 83-94%, 94-98%, 93-100% and 79-86%; accuracy 66-68%, 74-79%, 89-91%, 61-65% and 68-72%, respectively. K values ranged 0.38-0.50, 0.05-0.25, -0.05-0.11, -0.01-0.15, and 0.40-0.66 for consolidation, nodule/mass, linear opacities, reticular opacities, and pleural effusion, respectively. CONCLUSION: S-CXR images, reconstructed with AIP technique, can be compared with conventional images in clinical practice and for educational purposes.
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Radiografia Torácica , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Tomografia Computadorizada por Raios X/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Radiografia Torácica/métodos , Adulto , Idoso de 80 Anos ou mais , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Doenças Pleurais/diagnóstico por imagem , Reprodutibilidade dos Testes , Variações Dependentes do ObservadorRESUMO
Pleural diseases include a spectrum of disorders broadly categorized into pneumothorax and pleural effusion. They often cause pain, breathlessness, cough, and reduced quality of life. The global burden of diseases reflects regional differences in conditions and exposures associated with pleural disease, such as smoking, pneumonia, tuberculosis, asbestos, cancer, and organ failure. Disease burden in high-income countries is overrepresented given the availability of data and disease burden in lower-income countries is likely underestimated. In the United States, in 2016, there were 42,215 treat-and-discharge visits to the emergency room for pleural diseases and an additional 361,270 hospitalizations, resulting in a national cost of $10.1 billion.
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Doenças Pleurais , Derrame Pleural , Pneumotórax , Humanos , Qualidade de Vida , Efeitos Psicossociais da Doença , Hospitalização , Doenças Pleurais/epidemiologia , Doenças Pleurais/terapiaRESUMO
PURPOSE: Preoperative assessment of pleural adhesion is crucial for appropriate surgical planning. This study aimed to quantitatively evaluate the usefulness of motion analysis using dynamic chest radiography (DCR) for assessing pleural adhesions. METHODS: Sequential chest radiographs of 146 lung cancer patients with or without pleural adhesions (n = 25/121) were obtained using a DCR system during respiration (registration number: 1729). The local motion vector was measured, and the percentage of poor motion area to the maximum expiration lung area (%lung area with poor motion) was calculated. Subsequently, percentage values ≥49.0% were considered to indicate pleural adhesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the prediction performance. The percentage of lung area with poor motion was compared between patients with and without pleural adhesions (p < 0.05). RESULTS: DCR-based motion analysis correctly predicted pleural adhesions in 21 out of 25 patients, with 47 false-positive results (sensitivity, 84.0%; specificity, 61.2%; PPV, 30.9%; NPV, 94.9%). The lung with pleural adhesions showed a significantly greater %lung area with poor motion than the opposite lung in the same patient, similar to the cancerous lung in patients without pleural adhesions. CONCLUSION: On DCR-based motion analysis, pleural adhesions could be indicated by an increase in the percentage of lung area with poor motion. Although the proposed method cannot identify the exact location of pleural adhesions, information regarding the presence or absence of pleural adhesions provided by DCR would help surgeons prepare for challenging surgeries and obtain informed consent from patients.
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Neoplasias Pulmonares , Doenças Pleurais , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Doenças Pleurais/diagnóstico por imagem , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , RadiografiaRESUMO
Medical thoracoscopy/pleuroscopy has become, after bronchoscopy, the second most commonly utilized endoscopic procedure in interventional pulmonology. Due to their common origin, medical thoracoscopy/pleuroscopy and video-assisted thoracic surgery (VATS) are quite similar procedures technically. In contrast to the prevailing attitude that it should predominantly be performed by interventional pulmonologists, we believe that, like all hybrid-in-nature techniques, it should be implemented as part of a combined specialist care service/team. Herewith, we describe our attempt to establish a multidisciplinary pleural disease program during a difficult economic period for our country, comprising thoracic surgeons, pulmonologists and anesthesiologists, all of whom brought in their experience, expertise and resources to establish and develop the service resulting in a hybridization of the technique, with, as reported, quite favorable results.
Assuntos
Pleura , Doenças Pleurais , Humanos , Doenças Pleurais/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Broncoscopia , Equipe de Assistência ao PacienteRESUMO
OBJECTIVE: Pleural adhesions are challenging during lung cancer surgery and may be associated with a long surgery time and excessive blood loss due to pleural adhesiolysis. We used preoperative four-dimensional computed tomography to quantitatively assess parietal pleural adhesions and determine its diagnostic accuracy. METHODS: A total of 216 patients with lung cancer underwent four-dimensional computed tomography during the study period. Pleural adhesions were subsequently confirmed by surgery in 85 of these patients, whereas 126 patients had no adhesions. The movements of the tumor or target vessels (α) was tracked. Receiver-operating characteristic curve analysis was used to identify the relationship between adhesions and (α). RESULTS: The movement of (α) was smaller in patients with adhesions than in those without adhesions. The greater the adhesion, the shorter the movement distance (p < 0.001). Receiver-operating characteristic curve analysis demonstrated an area under the curve for the moving (α) point at 0.71 (95% confidence interval: 0.62-0.80) in the upper lung field and at 0.75 (95% confidence interval: 0.64-0.85) in the lower field. To identify adhesions, a cut off of 11.3 mm (sensitivity = 43.6%, specificity = 93.2%) in the upper lung field and a cut off of 41.2 mm (sensitivity = 71.4%, specificity = 66.0%) in the lower lung field were established. CONCLUSIONS: Four-dimensional computed tomography is a novel and helpful modality for predicting the presence of parietal pleural adhesions. To obtain robust evidence, further accumulation of cases and re-examination of the analysis methods are needed.
Assuntos
Neoplasias Pulmonares , Doenças Pleurais , Parede Torácica , Humanos , Parede Torácica/patologia , Tomografia Computadorizada Quadridimensional/métodos , Doenças Pleurais/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/complicações , Pleura/patologia , Aderências Teciduais/diagnóstico por imagemRESUMO
BACKGROUND AND OBJECTIVE: Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) therapy is increasingly used in pleural infection. Bleeding risks and costs associated with tPA remain the clinical concerns. Our dose de-escalation series aims to establish the lowest effective dosing regimen for tPA/DNase. This study assesses the intrapleural use of 2.5 mg tPA/5 mg DNase for pleural infection. METHODS: Consecutive patients with pleural infection treated with a starting regime of 2.5 mg tPA/5 mg DNase were included from two centres in Australia and UK. Escalation of tPA dose was permitted if clinical response was inadequate. RESULTS: Sixty-nine patients (mean age 61.0 years) received intrapleural 2.5 mg tPA/5 mg DNase. Most (88.4%) were treated successfully and discharged from hospital without surgery by 90 days. Patients received a median of 5 [interquartile range [IQR] = 3-6] doses of tPA/DNase. Total amount of tPA used per patient was 12.5 mg [median, IQR = 7.5-15.0]. Seventeen patients required dose escalation of tPA; most (n = 12) for attempted drainage of distant non-communicating locule(s). Treatment success was corroborated by clearance of pleural opacities on radiographs (from median 27.0% [IQR = 17.1-44.5] to 11.0% [IQR = 6.4-23.3] of hemithorax, p < 0.0001), increased pleural fluid drainage (1.98 L [median, IQR = 1.38-2.68] over 72 h following commencement of tPA/DNase) and reduction of serum C-reactive protein level (by 45.0% [IQR = 39.3-77.0] from baseline at day 5, p < 0.0001). Two patients required surgery. Six patients with significant comorbidities (e.g., advanced cancer) had ongoing infection when palliated and died. Two patients experienced self-limiting pleural bleeding and received blood transfusion. CONCLUSION: A starting intrapleural regime of 2.5 mg tPA/5 mg DNase, with up-titration if needed, can be effective and deserves further exploration.
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Empiema Pleural , Doenças Pleurais , Derrame Pleural , Desoxirribonucleases/uso terapêutico , Empiema Pleural/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Humanos , Pessoa de Meia-Idade , Doenças Pleurais/complicações , Doenças Pleurais/tratamento farmacológico , Derrame Pleural/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
Introducción: Los cambios en la tecnología médica abarcan todas las especialidades y dentro de ellas, en la cirugía general. Las técnicas mínimamente invasivas han ocupado un papel cimero en el diagnóstico y tratamiento de enfermedades en la cavidad torácica. Objetivo: Describir el uso de las técnicas mínimamente invasivas en el diagnóstico de enfermedades intratorácicas. Métodos: Se realizó un estudio observacional, retrospectivo de corte transversal para evaluar el uso de técnicas mínimamente invasivas en el diagnóstico de las enfermedades intratorácicas en el Hospital Universitario "Manuel Ascunce Domenech" desde enero de 2017 hasta mayo de 2020. El universo estuvo compuesto por 104 pacientes con sospecha diagnóstica de enfermedades benignas o malignas del tórax. Resultados: La mayor parte de los pacientes con enfermedades benignas y malignas del tórax tenían una edad de 49 (±7,05) años, sin significación intersexo. La hipertensión arterial predominó como principal comorbilidad. La videotoracoscopia fue la técnica mínimamente invasiva más empleada y la sospecha de cáncer pulmonar y enfermedad pleural constituyeron las indicaciones más frecuentes que motivaron el proceder. El diagnóstico posoperatorio que predominó en la serie fue el cáncer pulmonar. Las técnicas mínimamente invasivas empleadas mostraron una alta validez. La mayoría de los pacientes egresaron vivos y sin complicaciones. Conclusiones: El uso de técnicas mínimamente invasivas en varias enfermedades intratorácicas son de vital importancia para definir diagnóstico y tratamiento(AU)
Introduction: Changes in medical technology cover all specialties and, within them, general surgery. Minimally invasive techniques have played a paramount role in the diagnosis and treatment of thoracic cavity diseases. Objective: To describe the use of minimally invasive techniques in the diagnosis of intrathoracic diseases. Methods: An observational, retrospective and cross-sectional study was carried out, from January 2017 to May 2020, in order to assess the use of minimally invasive techniques in the diagnosis of intrathoracic diseases at Manuel Ascunce Domenech University Hospital. The universe was made up of 104 patients with suspected benign or malignant diseases of the chest. Results: Most of the patients with benign and malignant chest diseases were 49 (± 7.05) years old, without intersex significance. Arterial hypertension predominated as the main comorbidity. Videothoracoscopy was the most widely used minimally invasive technique, while suspicion of lung cancer and pleural disease were the most frequent indications that motivated the procedure. The postoperative diagnosis that predominated in the series was lung cancer. The minimally invasive techniques used showed high validity. Most of the patients were discharged alive and without complications. Conclusions: The use of minimally invasive techniques in various intrathoracic diseases are of vital importance to define diagnosis and treatment(AU)
Assuntos
Humanos , Doenças Pleurais/etiologia , Comorbidade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Cavidade Torácica/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Estudos Transversais , Estudos Retrospectivos , Estudos Observacionais como AssuntoRESUMO
BACKGROUND: Comprehensive US epidemiologic data for adult pleural disease are not available. RESEARCH QUESTION: What are the epidemiologic measures related to adult pleural disease in the United States? STUDY DESIGN AND METHODS: Retrospective cohort study using Healthcare Utilization Project databases (2007-2016). Adults (≥ 18 years of age) with malignant pleural mesothelioma, malignant pleural effusion, nonmalignant pleural effusion, empyema, primary and secondary spontaneous pneumothorax, iatrogenic pneumothorax, and pleural TB were studied. RESULTS: In 2016, ED treat-and-discharge (T&D) visits totaled 42,215, accounting for charges of $286.7 million. In 2016, a total of 361,270 hospitalizations occurred, resulting in national costs of $10.1 billion. A total of 64,174 readmissions contributed $1.16 billion in additional national costs. Nonmalignant pleural effusion constituted 85.5% of ED T&D visits, 63.5% of hospitalizations, and 66.3% of 30-day readmissions. Contemporary sex distribution (male to female ratio) in primary spontaneous pneumothorax (2.1:1) differs from older estimates (6.2:1). Decadal analyses of annual hospitalization rates/100,000 adult population (2007 vs 2016) showed a significant (P < .001) decrease for malignant pleural mesothelioma (1.3 vs 1.09, respectively), malignant pleural effusion (33.4 vs 31.9, respectively), iatrogenic pneumothorax (17.9 vs 13.9, respectively), and pleural TB (0.20 vs 0.09, respectively) and an increase for empyema (8.1 vs 11.1, respectively) and nonmalignant pleural effusion (78.1 vs 100.1, respectively). Empyema hospitalizations have high costs per case ($38,591) and length of stay (13.8 days). The mean proportion of readmissions attributed to a pleural cause varied widely: malignant pleural mesothelioma, 49%; malignant pleural effusion, 45%; nonmalignant pleural effusion, 31%; empyema, 27%; primary spontaneous pneumothorax, 27%; secondary spontaneous pneumothorax, 27%; and iatrogenic pneumothorax, 20%. Secondary spontaneous pneumothorax had the shortest time to readmission in 2016 (10.3 days, 95% CI, 8.8-11.8 days). INTERPRETATION: Significant epidemiologic trends and changes in various pleural diseases were observed. The analysis identifies multiple opportunities for improvement in management of pleural diseases.
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Doenças Pleurais/epidemiologia , Adolescente , Adulto , Idoso , Empiema/economia , Empiema/epidemiologia , Feminino , Coalizão em Cuidados de Saúde , Gastos em Saúde , Hospitalização/economia , Humanos , Incidência , Masculino , Mesotelioma Maligno/economia , Mesotelioma Maligno/epidemiologia , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Doenças Pleurais/economia , Derrame Pleural/economia , Derrame Pleural/epidemiologia , Derrame Pleural Maligno , Neoplasias Pleurais/economia , Neoplasias Pleurais/epidemiologia , Pneumotórax/economia , Pneumotórax/epidemiologia , Tuberculose Pleural/economia , Tuberculose Pleural/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Idiopathic pleuropulmonary fibroelastosis is an extremely rare lung disease characterized by the combination of fibrosis of the visceral pleura and the fibroelastotic changes transcending in the subpleural lung parenchyma that predominantly affects the upper lobes with accompanying volume loss. It is mostly idiopathic while infection, autoimmunity, bone marrow or lung transplantation and genetic predisposition may be associated with the development of PPFE. The disease is exceptionally rare as approximately ninety cases have been reported in the literature currently. A 35-year-old female presented with exertional dyspnea, dry cough and weight loss. Physical examination demonstrated platythorax, suprasternal notch deepening and fine rales over the upper lobes. Blood count, serum biochemistry, autoimmunity and serologic markers for collagen vascular diseases were within normal limits. Arterial blood gases demonstrated a low pO2 (48 mm Hg) and a high pCO2 (54 mm Hg) values. Chest x-ray showed bilateral parenchymal fibrotic lesions, left pneumothorax, bronchiectasis in the middle and pleural thickening in the upper lung zones while HRCT revealed bilateral apical pleural thickening, traction bronchiectasis, subpleural reticulations, ground-glass opacities and honeycombing in the upper lobes. Bronchoscopy, BAL cytology, smear and culture did not reveal any pathologic findings. Relevant with the clinical, laboratory, radiologic manifestations and the differential diagnosis with other interstitial lung diseases, PPFE was the final diagnosis. The aim of this case report was to present the clinical manifestations of our case. The second crucial objective was to establish a diagnostic scoring system relevant with the literature and the clinical manifestations of the patient.
Assuntos
Doenças Pulmonares Intersticiais , Transplante de Pulmão , Doenças Pleurais , Adulto , Feminino , Humanos , Pulmão , Pleura/diagnóstico por imagem , Doenças Pleurais/diagnóstico por imagemRESUMO
The S2k guideline "Diagnostics and assessment of occupational asbestos-related diseases" was updated in November 2020. This article summarizes the most important changes. There is a new reference to the risk of potentially high exposures to asbestos fibers when renovating plaster, fillers and adhesives containing asbestos.Biomarkers such as mesothelin and calretinin should currently only be used in the context of research. The "asbestos airways disease", which can only be diagnosed histologically, is included in the guideline as an early form of asbestosis. Since the UIP pattern is not characteristic of asbestosis, computed tomography cases with UIP patterns alone cannot be assigned reliably to asbestosis without the simultaneous detection of pleural plaques. With regard to the evaluation of the functional damage, attention is drawn to the importance of flow volume curve, whole-body plethysmography, diffusion capacity and exercise testing. If available, the reference values ââaccording to GLI are the basis of the assessment. The guideline contains specific recommendations on prevention, medical treatment and, for the first time, on the importance of outpatient rehabilitation and training therapy. There are also references to the assessment of the new occupational disease ovarian cancer after occupational exposure to asbestos.
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Amianto , Asbestose , Doenças Profissionais , Exposição Ocupacional , Doenças Pleurais , Amianto/toxicidade , Asbestose/diagnóstico , Humanos , Doenças Profissionais/diagnóstico , Exposição Ocupacional/efeitos adversosRESUMO
PURPOSE: To assess the usefulness of software analysis using dynamic-ventilation CT for localized pleural adhesion (LPA). MATERIALS AND METHODS: Fifty-one patients scheduled to undergo surgery underwent both dynamic-ventilation CT and static chest CT as preoperative assessments. Five observers independently evaluated the presence and severity of LPA on a three-point scale (non, mild, and severe LPA) for 9 pleural regions (upper, middle, and lower pleural aspects on ventral, lateral, and dorsal areas) on the chest CT by three different methods by observing images from: static high-resolution CT (static image); dynamic-ventilation CT (movie image), and dynamic-ventilation CT while referring to the adhesion map (movie image with color map), which was created using research software to visualize movement differences between the lung surface and chest wall. The presence and severity of LPA was confirmed by intraoperative thoracoscopic findings. Parameters of diagnostic accuracy for LPA presence and severity were assessed among the three methods using Wilcoxon signed rank test in total and for each of the three pleural aspects. RESULTS: Mild and severe LPA were confirmed in 14 and 8 patients. Movie image with color map had higher sensitivity (56.9⯱â¯10.7 %) and negative predictive value (NPV) (91.4⯱â¯1.7 %) in LPA detection than both movie image and static image. Additionally, for severe LPA, detection sensitivity was the highest with movie image with color map (82.5⯱â¯6.1 %), followed by movie image (58.8⯱â¯17.0 %) and static image (38.8⯱â¯13.9 %). For LPA severity, movie image with color map was similar to movie image and superior to static image in accuracy as well as underestimation and overestimation, with a mean value of 80.2 %. CONCLUSION: Software-assisted dynamic-ventilation CT may be a useful novel imaging approach to improve the detection performance of LPA.
Assuntos
Doenças Pleurais , Humanos , Pulmão , Doenças Pleurais/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Respiração , Software , Tomografia Computadorizada por Raios XRESUMO
There is an evolution of pleural procedures that involve broadened clinical indication and expanded scope that include advanced diagnostic, therapeutic, and palliative procedures. Finance and clinical professionals have been challenged to understand the indication and coding complexities that accompany these procedures. This article describes the utility of pleural procedures, the appropriate current procedural terminology coding, and necessary modifiers. Coding pearls that help close the knowledge gap between basic and advanced procedures aim to address coding confusion that is prevalent with pleural procedures and the risk of payment denials, potential underpayment, and documentation audits.
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Current Procedural Terminology , Técnicas e Procedimentos Diagnósticos , Doenças Pleurais , Procedimentos Cirúrgicos Torácicos , Técnicas e Procedimentos Diagnósticos/classificação , Técnicas e Procedimentos Diagnósticos/economia , Humanos , Doenças Pleurais/diagnóstico , Doenças Pleurais/economia , Doenças Pleurais/terapia , Pneumologia/economia , Pneumologia/métodos , Pneumologia/tendências , Escalas de Valor Relativo , Procedimentos Cirúrgicos Torácicos/economia , Procedimentos Cirúrgicos Torácicos/métodosRESUMO
We retrospectively assessed the clinical and pathological features of 14 patients with thoracic endometriosis who were treated at our hospital from 2007 to 2017. Thirteen patients presented pneumothorax and 1 patient presented bloody sputum. All were treated surgically. Pneumothorax occurs on the right side in all 13 cases and bloody sputum was from left side lesion. Ten patients presented symptoms closely related with their menstrual cycle (days -2 to 5). At surgery, dark red or dark brown spots, small hiatus and scar-like findings on the surface of the visceral pleura or diaphragm were identified in all cases. Pathological or immunohistochemical examinations of diaphragm or lung tissue specimens revealed endometrial tissue in 6 cases of pneumothorax and a case of bloody sputum. Nine patients received hormonal therapy(8:pneumothorax, 1:bloody sputum). Pleurodesis was performed for 1 pneumothorax patient with recurrent pneumothorax after hormonal therapy. In case of young female with repeated pneumothorax, catamenial pneumothorax must be kept in mind as a differential diagnosis and appropriate timing for surgical treatment should be considered to establish pathologically correct diagnosis.
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Diafragma , Endometriose , Doenças Musculares , Doenças Pleurais , Pneumotórax , Endometriose/complicações , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Menstruação , Doenças Musculares/complicações , Doenças Musculares/patologia , Doenças Musculares/cirurgia , Doenças Pleurais/complicações , Doenças Pleurais/patologia , Doenças Pleurais/cirurgia , Pleurodese , Pneumotórax/etiologia , Pneumotórax/patologia , Pneumotórax/terapia , Recidiva , Estudos Retrospectivos , EscarroRESUMO
OBJECTIVES: This study has researched the significance of histologically raised findings and lung dust analyses in the context of claiming the recognition of and thus compensation for an asbestos-associated occupational disease. MATERIAL AND METHODS: For this approach, all findings from the German Mesothelioma Register in 2015 that included lung dust analyses were evaluated and were compared with information on asbestos fiber exposure at work based on fiber years, and with the results of radiological findings. RESULTS: For 68 insured persons, recognition of an asbestos-induced lung disease according to Section 4104 of the German Ordinance on Occupational Diseases (Berufskrankheitenverordnung - BKV) could be recommended solely on the basis of the histological examinations of lung tissues and complementary lung dust analyses. Neither did the calculation of the cumulative asbestos dust exposure at work yield 25 fiber years, nor could bridge findings (e.g., plaques) be identified. In addition, the autopsies of 12 patients revealed plaques that had not been diagnosed during radiological examinations. These results show that - irrespective of the prescribed working techniques and radiological diagnosis - pathological/anatomical and histological diagnostics are often the only way for the insureds to demonstrate the causal connection between asbestos and their disease. Even after long intervals of up to 40 years post last exposure, the asbestos fibers would still be easily detectable in the lung tissues evaluated. CONCLUSIONS: Whenever suitable tissue is available, it should be examined for mild asbestosis with the aid of a lung dust analysis. Otherwise there is a risk that an occupational disease is wrongfully rejected. In the context of health insurance, the lung dust analysis and the resulting proof of the presence of asbestosis often constitute one option of providing evidence of an occupational disease. Int J Occup Med Environ Health 2018;31(3):293-305.
Assuntos
Amianto/análise , Asbestose/diagnóstico , Pneumopatias/diagnóstico , Doenças Profissionais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Asbestose/diagnóstico por imagem , Asbestose/patologia , Poeira/análise , Alemanha , Técnicas Histológicas , Humanos , Pneumopatias/patologia , Pessoa de Meia-Idade , Doenças Profissionais/patologia , Exposição Ocupacional/estatística & dados numéricos , Doenças Pleurais/diagnóstico , Doenças Pleurais/patologia , Indenização aos TrabalhadoresRESUMO
PURPOSE: To assess the feasibility of Four-Dimensional Ultra-Low-Dose Computed Tomography (4D-ULDCT) for distinguishing pleural aspects with localized pleural adhesion (LPA) from those without. METHODS: Twenty-seven patients underwent 4D-ULDCT during a single respiration with a 16cm-coverage of the body axis. The presence and severity of LPA was confirmed by their intraoperative thoracoscopic findings. A point on the pleura and a corresponding point on the outer edge of the costal bone were placed in identical axial planes at end-inspiration. The distance of the two points (PCD), traced by automatic tracking functions respectively, was calculated at each respiratory phase. The maximal and average change amounts in PCD (PCDMCA and PCDACA) were compared among 110 measurement points (MPs) without LPA, 16MPs with mild LPA and 10MPs with severe LPA in upper lung field cranial to the bronchial bifurcation (ULF), and 150MPs without LPA, 17MPs with mild LPA and 9MPs with severe LPA in lower lung field caudal to the bronchial bifurcation (LLF) using the Mann-Whitney U test. RESULTS: In the LLF, PCDACA as well as PCDMCA demonstrated a significant difference among non-LPA, mild LPA and severe LPA (18.1±9.2, 12.3±6.2 and 5.0±3.3mm) (p<0.05). Also in the ULF, PCDACA showed a significant difference among three conditions (9.2±5.5, 5.7±2.8 and 2.2±0.4mm, respectively) (p<0.05), whereas PCDMCA for mild LPA was similar to that for non-LPA (12.3±5.9 and 17.5±11.0mm). CONCLUSIONS: Four D-ULDCT could be a useful non-invasive preoperative assessment modality for the detection of the presence or severity of LPA.
Assuntos
Tomografia Computadorizada Quadridimensional/métodos , Imageamento Tridimensional/métodos , Doenças Pleurais/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pleura/diagnóstico por imagem , Doses de Radiação , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não ParamétricasAssuntos
Pneumologia/métodos , Pneumologistas/educação , Sociedades Médicas/organização & administração , Obstrução das Vias Respiratórias/terapia , Asma/terapia , Humanos , Doenças Pleurais/terapia , Enfisema Pulmonar/terapia , Pneumologia/economia , Pneumologia/educação , Pneumologia/organização & administraçãoRESUMO
INTRODUCTION: Bronchopleural fistula is a rare but potentially fatal complication of pulmonary resections and proper management is essential for its resolution. In this study, we analyzed the incidence of fistula after pulmonary resection and reported data about endoscopic and conservative treatments of this complication. METHODS: From January 2003 to December 2013, 835 patients underwent anatomic lung resections: 786 (94.1 %) had a lobectomy and 49 (5.9 %) a pneumonectomy. Bronchopleural fistula was suspected by clinical signs and confirmed by endoscopic visualization. RESULTS: Eighteen patients (2.2 %) developed a bronchopleural fistula, 11 in lobectomy group (1.4 %) and 7 in pneumonectomy group (14.3 %). The fistula size ranged between <1 mm and 6 mm and mean time of fistula onset was 33.9 ± 54.9 days after surgery. Of 18 patients who developed fistula, one died due to acute respiratory failure and another one was reoperated and then died to causes unrelated to the treatment. All the remaining 16 patients were treated with a conservative therapy that consisted in keeping or replacing a drainage chest tube. Nine of them underwent also endoscopic closure of the fistula using biological or synthetic glues. The mean period of time elapsed for the resolution of this complication was shorter with combined (conservative + endoscopic) than with conservative treatment alone (15.4 ± 13.2 vs. 25.8 ± 13.2 days, respectively), but without significant difference between the two methods (p: 0.299). CONCLUSION: Endoscopic therapy, associated with a conservative treatment, is a safe and useful option in the management of the postoperative bronchopleural fistula.
Assuntos
Fístula Brônquica/epidemiologia , Fístula Brônquica/terapia , Broncoscopia , Drenagem , Doenças Pleurais/epidemiologia , Doenças Pleurais/terapia , Pneumonectomia/efeitos adversos , Fístula do Sistema Respiratório/epidemiologia , Fístula do Sistema Respiratório/terapia , Idoso , Fístula Brônquica/diagnóstico , Fístula Brônquica/mortalidade , Tubos Torácicos , Drenagem/instrumentação , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico , Doenças Pleurais/mortalidade , Pneumonectomia/mortalidade , Reoperação , Fístula do Sistema Respiratório/diagnóstico , Fístula do Sistema Respiratório/mortalidade , Cidade de Roma/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this study was to elucidate whether there is a relationship between the extent of pleural plaques and pulmonary asbestos body concentration (PABC). METHODS: The subjects were 207 lung cancer patients with occupational asbestos exposure. We determined the plaque extent by findings on chest images using our own criteria. PABCs were measured in resected or autopsy lung specimens. RESULTS: There was a significant relationship between plaque extent and PABC. Seventy-five percent of the patients determined to have extensive plaques based on our criteria had a PABC of ≥5,000 asbestos bodies per gram of dry lung tissue, which is one of the certification criteria of lung cancer caused by asbestos for workers' compensation in Japan. CONCLUSIONS: In lung cancer patients, the plaque extent had a significant positive relationship with the PABC. The plaque extent would be useful as a proxy for PABC for lung cancer compensation purposes.
Assuntos
Amianto/análise , Neoplasias Pulmonares/etiologia , Pulmão/química , Doenças Profissionais/diagnóstico por imagem , Exposição Ocupacional/análise , Doenças Pleurais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Amianto/toxicidade , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Doenças Pleurais/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Indenização aos TrabalhadoresRESUMO
Interest in transthoracic ultrasound (US) procedures increased after the availability of portable US equipment suitable for use at the patient's bedside. It is possible to detect space-occupying lesions of the pleura, pleural effusion, focal or diffuse pleural thickening and subpleural lesions of the lung, even in emergency settings. Transthoracic US is useful as a guidance system for thoracentesis and peripheral lesion biopsy, where it minimises the occurrence of pneumothorax and haemorrhage. Transthoracic US imaging is strongly influenced by physical interaction of the ultrasonic beam at the tissue/air interface, which gives rise to reverberations classified as simple (A-line), "comet tail" and "ring down"(B-line) artifacts. Although these artifacts can be suggestive of a disease condition, they are essentially imaging errors present even in normal subjects and in empty-pleura post-pneumonectomy patients. In order to clarify some confusion and to report on the state of the art, we present a review of the literature on transthoracic US in diseases of the pleura and peripheral lung regions and our own clinical experience over 3 decades. The review focuses on quality assurance procedures and their value in diagnostic imaging and patient monitoring and warns against possible inappropriate indications and misleading information. Thoracic US is much more than "fishing for the moon in the well".
Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/patologia , Artefatos , Humanos , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodos , Ultrassonografia de Intervenção/métodosRESUMO
In clinical medicine since some years overdiagnosis is giving rise to growing attention and concern. Overdiagnosis is the diagnosis of a "disease" that will never cause symptoms or death during a patient's lifetime. It is a side effect of testing for early forms of disease which may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted. Four drivers engender overdiagnosis: 1) screening in non symptomatic subjects; 2) raised sensitivity of diagnostic tests; 3) incidental overdiagnosis; 4) broadening of diagnostic criteria for diseases. "Defensive medicine" can play a role. It begs the question of whether even in the context of Occupational Medicine overdiagnosis is possible. In relation to the double diagnostic evaluation peculiar to Occupational Medicine, the clinical and the causal, a dual phenomenon is possible: that of overdiagnosis properly said and what we could define the overattribution, in relation to the assessment of a causal relationship with work. Examples of occupational "diseases" that can represent cases of overdiagnosis, with the possible consequences of overtreatment, consisting of unnecessary and socially harmful limitations to fitness for work, are taken into consideration: pleural plaques, alterations of the intervertebral discs, "small airways disease", sub-clinical hearing impairment. In Italy the National Insurance for occupational diseases (INAIL) regularly recognizes less than 50% of the notified diseases; this might suggest overdiagnosis and possibly overattribution in reporting. Physicians dealing with the diagnosis of occupational diseases are obviously requested to perform a careful, up-to-date and active investigation. When applying to the diagnosis of occupational diseases, proper logical criteria should be even antecedent to a good diagnostic technique, due to social outcome for the worker.