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At least 19 recordsLinked to original sources
PubMed1997

Radiographic and computed tomography (CT) imaging of complex pleural disease.

Pleural diseases encompass a variety of complex appearances that are dependent on the underlying histologic features, location, and size. Chest radiography remains the most common imaging modality in the evaluation of suspected pleural disease. Computed tomography (CT) further delineates the cross-sectional anatomy, allowing visualization of the entire pleura, including the posterior recesses, mediastinal, and lateral pleural surfaces, which are frequently obscured on chest radiographs. CT imaging provides useful information to characterize the pleural disease in terms of tissue composition, location, and extent of disease. In this article, we review the use of two noninvasive techniques: chest radiography and computed tomography in the evaluation of complex pleural disease, benign and malignant pleural masses, pleural effusions, and pleural air collections.

Bronchial Fistula↗
PubMedDate not supplied

[Contribution of thoracoscopic brushing to the diagnosis of pleural diseases].

Pleural brushing can be performed under thoracoscopic examination. The combined use of all three methods of diagnosis (macroscopy, biopsy, cytology) achieved optimal diagnostic results. From September 1980 to October 1981 we have performed 150 thoracoscopies for pleural effusions, while the results of conventional pleural cytology and biopsy were negative. In 108 cases pleural brushing and biopsy were both performed. The diagnosis was in 37 cases non malignant diseases states associated with effusions and in 71 cases tumoral effusions. Among the 37 cases of non malignant diseases states associated with effusions were: 6 mechanical effusions, 27 inflammatory processes, 4 infectious processes. Among the 71 cases of tumoral effusions were 3 benign pleural lipomas, 50 metastatic carcinomas, 18 carcinomatous mesotheliomas. We studied the diagnostic accuracy of pleural brushing: in non malignant diseases, pleural brushing show the non tumoral features of the process, in metastatic tumours, biopsy was positive in 80% of the cases; pleural brushing in 78% of cases; taken together they allowed the diagnosis in 86% of the cases, in carcinomatous mesotheliomas biopsy was positive in 82,3%, pleural brushing in 78%; taken together they allowed the diagnosis in 89% of the cases. Pleural brushing allows a rapid cytological diagnosis, enhances the histological results and may also be used to get cellular material in areas dangerous to biopsy.

Adenocarcinoma↗
PubMed1984

[Thoracoscopy with pleural brushing. A new diagnostic method for pleural diseases].

Pleural brushing can be performed under thoracoscopic examination. The combined use of all three methods of diagnosis (macroscopy, biopsy, cytology) achieved optimal diagnostic results. From September 1980 to October 1981 we have performed 150 thoracoscopies for pleural effusions, while the results of conventional pleural cytology and biopsy were negative. In 108 cases pleural brushing and biopsy were both performed. The diagnosis was in 37 cases non malignant disease states associated with effusions and in 71 cases tumoural effusions. Among the 37 cases of non malignant diseases states associated with effusions were 6 mechanical effusions, 27 inflammatory processes, 4 infectious processes. Among the 71 cases of tumoural effusions were 3 benign pleural lipomas, 50 metastatic carcinomas, 18 carcinomatous mesotheliomas. We studied the diagnostic accuracy of pleural brushing: in non malignant diseases pleural brushing show the non tumoural features of the process, in metastatic tumours biopsy was positive in 80% of the cases; pleural brushing in 78% of cases; taken together they allowed the diagnosis in 86% of the cases, in carcinomatous mesotheliomas biopsy was positive in 82.3%, pleural brushing in 78%; taken together they allowed the diagnosis in 89% of the cases. Pleural brushing allows a rapid cytological diagnosis, enhances the histological results and may be used to get cellular material in areas dangerous to biopsy.

Adenocarcinoma↗
PubMed1990

Amyloidosis and pleural disease.

Pleural involvement with systemic amyloidosis has been reported rarely in the literature. Diagnosis of this entity by percutaneous needle biopsy of the pleura has been described only in two prior case reports. We describe five patients in whom the diagnosis of pleural amyloidosis was established by Cope needle biopsy during evaluation of pleural effusions of indeterminate cause. Three patients presented with a history suggestive of multiorgan disease and a pleural biopsy performed despite a transudative effusion demonstrated amyloid infiltration of the pleura, obviating the need for other organ biopsies. We conclude that in patients with pleural effusions, if history suggests multiorgan involvement and there is suspicion for amyloidosis, then a closed pleural biopsy with special stains for amyloid should be performed even if the effusions are transudative. This may be the diagnostic procedure of choice in such patients.

Aged↗
PubMed2001

[Management of malignant pleural diseases].

Pleural effusions are the oldest indication of the thoracoscopic treatment. They represent the terminal state of malignancy and the aim of the treatment is palliative. The most effective is the thoracoscopic procedure in general anaesthesia with one lung ventilation and application of talc powder. We have been using videothoracoscopy in such cases since 1993 and we have treated more than 700 patients. The thoracoscopic procedure was successful in 70% of cases.

Humans↗
PubMed2000

Asbestos-related benign pleural disease.

Benign pleural disease is the commonest manifestation of asbestos exposure encountered by radiologists. Benign pleural thickening can appear as circumscribed parietal pleural plaques or as more diffuse thickening of the visceral pleura. Benign-asbestos induced pleural effusions are a significant and under-recognized manifestation of asbestos exposure with important sequelae, such as diffuse pleural thickening which may be associated with functional impairment and for which compensation may be sought. This review concentrates on the strengths and weaknesses of chest radiography and computed tomography for the detection and characterization of benign asbestos-related pleural disease and the relevance of imaging abnormalities to compensation and functional impairment.Peacock, C. (2000). Clinical Radiology55, 422-432.

Asbestos↗
PubMed2005

Pleural disease in silicosis: pleural thickening, effusion, and invagination.

PURPOSE: To retrospectively evaluate pleural disease on images from patients with autopsy-proved silicosis. MATERIALS AND METHODS: The study had institutional review board approval, and informed consent from relatives of diseased subjects was waived. Lung specimens were obtained at autopsy in 110 men (mean age, 72 years) who had been followed up radiologically for a mean of 14.8 years. Computed tomographic (CT) scans obtained within 2 years before death were examined for presence of pleural thickening; shape, composition, size, and subpleural location of progressive massive fibrosis (PMF); and pleural invagination (bandlike structure between lesion and pleura). Lung specimens were reviewed and compared with CT findings. Serial chest radiographs and CT scans were reviewed for presence of pleural effusion. Association between radiographic findings and pleural invagination was analyzed with chi2 and Student t tests. Multiple logistic regression analysis was used to find predictive variables for pleural invagination. RESULTS: Pleural effusion was found in 12 (11%) patients at chest radiography and CT, and thickening was found in 64 (58%) patients at CT; the latter finding was significantly more frequent with complicated silicosis (P < .001). At CT, 128 PMF lesions were seen, 39 (30%) of which showed pleural invagination; CT scans showed pleural thickening in 36 (92%) of these 39 lesions. In 17 (44%) PMF lesions, CT scans depicted a bandlike structure that was pathologically confirmed to represent invaginated pleura in all cases. Pathologic presence of invagination was significantly associated with pleural thickening (P < .001), ipsilateral pleural effusion (P < .01), interstitial fibrosis (P < .05), and the nearness of PMF to the pleura (P < .005). Multiple logistic regression analysis showed that pleural thickening (odds ratio, 62.51; 95% confidence interval [CI]: 5.564, 70.2) and pleural effusion (odds ratio, 25.865; 95% CI: 1.992, 335.8) were significant CT variables associated with presence of pathologic pleural invagination (P = .001 and .013, respectively). Five PMF lesions had radiographic features of rounded atelectasis. CONCLUSION: Various pleural abnormalities can occur in silicosis, especially in advanced disease.

Aged↗
PubMed2004

Drug-induced pleural disease.

Drug-induced pleural disease is uncommon and less known to clinicians than drug-induced parenchymal lung disease. Pleural reactions from drugs manifest as pleural effusions, pleural thickening, or pleuritic chest pain, and may occur in the absence of parenchymal infiltrates. The clinician should be cognizant of the possibility of a drug-induced pleural reaction. A detailed drug history, temporal relationship between symptom onset and initiation of therapy, and pleural fluid eosinophilia should raise the suspicion of a drug-related process. We suspect that as new drugs are marketed in the United States, the number of drugs that result in pleuropulmonary toxicity will continue to increase. Moreover, if the cause of an exudative pleural effusion is not clinically obvious after pleural fluid analysis, drug therapy withdrawal should be a consideration if clinically appropriate before initiating an extensive diagnostic evaluation that may entail unnecessary economic burden and discomfort for the patient.

Anti-Infective Agents, Urinary↗
PubMed2000

Benign pleural diseases.

The pleural space is a potential space under normal physiologic circumstances. It envelops the lung, the mediastinum, the diaphragm and the chest wall. A thin film of pleural fluid provides lubrication for the two pleural layers; only 2-10 ml of pleural fluid is present in healthy people. For the purposes of this review, pleural abnormalities will be divided into pleural effusion, pneumothorax, and pleural calcification.

Diagnosis, Differential↗
PubMed1979

A study on acid glycosaminoglycans in pleural diseases.

1. Pleural fluid contained protein-bound hyaluronic acid, protein-bound chondroitin sulfate, hyaluronic acid, chondroitin sulfate, undersulfated chondroitin sulfate and dermatan sulfate. The composition of acid glycosaminoglycans in pleural fluid seems to reflect the rate of biosynthesis and degradation of these polysaccharides at some sites which are closely related to the pleural cavity. 2. A possibility was suggested that hyaluronic acid was synthesized in pleural tissue and was excreted shortly thereafter into the surroundings, as evidenced by experiments with rabbit pleural tissue. 3. In human, hyaluronic acid, chondroitin sulfate, dermatan sulfate and heparan sulfate were found in thickened pleurae caused by lung cancer, in those caused by asbestosis and also in tumor tissues of pleural mesothelioma. The molecular size of hyaluronic acid from pleural mesothelioma was found to be larger than that from human unbilical cord. 4. Quantification and histochemical study of acid glycosaminoglycans demonstrated that the quantity of hyaluronic acid in tissue specimens of mesothelioma by far exceeded that in non-mesothelioma cases (statistically significant). 5. Thus a possibility was suggested that histochemical investigation together with microquantitation of hyaluronic acid in pleural tissue may prove to be an efficient means of differential diagnosis of pleural mesothelioma. 6. Definite conclusion on the relationship between the fluctuation with time in quantity of acid glycosaminoglycans of the effusions and etiology of pleurisy awaits further investigations.

Adult↗
PubMed2003

Benign asbestos pleural diseases.

The global incidence of asbestos-related lung diseases is expected to continue to rise. Although much attention is devoted to malignant diseases induced by asbestos, benign asbestos pleural diseases (pleural plaques, benign asbestos-related pleural effusion, diffuse pleural thickening, and rounded atelectasis) are common in clinical practice and often produce diagnostic difficulties. The authors describe the clinical features of benign asbestos-related pleural disease, before focusing on recent advances in radiology and on controversies surrounding the pathogenesis of asbestos-induced pleural injury. Advances in computed tomography have assisted the understanding and diagnosis of these diseases, and increasing evidence suggests radiologic appearances on computed tomography can predict impairment in pulmonary function tests. The pathogenesis of asbestos-induced pleural diseases has also been subject to extensive investigation. Asbestos fibers can provoke pleural inflammation from direct toxicity to mesothelial cells. Inhaled asbestos fibers can also elicit pleural injury indirectly via the release of growth factors and inflammatory cytokines from within the lung. Although progress has been made in the understanding of the mechanisms of asbestos pleural injury, many important questions remain unanswered. The role of genetic factors and possible environmental cofactors (eg, simian virus 40) in the pathogenesis of benign asbestos pleural diseases requires further research.

Asbestos↗
PubMed1992

A new high resolution computed tomography scoring system for pulmonary fibrosis, pleural disease, and emphysema in patients with asbestos related disease.

The aim of this study was to describe a scoring system for high resolution computed tomographic (HRCT) scans analogous to the International Labour Office (ILO) scoring system for plain chest radiographs in patients with asbestos related disease. Interstitial fibrosis, pleural disease, and emphysema were scored, the reproducibility and the interobserver agreement using this scoring system were examined, and the extent of the various types of disease was correlated with measurements of lung function. Sixty asbestos workers (five women and 55 men) mean age 59 (range 34-78) were studied. The lungs were divided into upper, middle, and lower thirds. An HRCT score for the extent of pleural disease and pulmonary disease in each third was recorded in a way analogous to the International Labour Office (ILO) method of scoring pleural and parenchymal disease on chest radiographs. A CT score for the extent of emphysema was also recorded. Pleural disease and interstitial fibrosis on the plain chest radiographs were assessed according to the ILO scoring system. A chest radiographic score for emphysema analogous to that used for HRCT was also recorded. Two independent readers assigned HRCT scores that differed by two categories or less in 96%, 92%, and 85% compared with 90%, 78%, and 79% of cases for chest radiographs for fibrosis, emphysema, and pleural disease respectively. There was better intraobserver repeatability for the HRCT scores than for the chest radiograph scores for all disorders. Multiple regression analysis showed that scores for interstitial fibrosis, emphysema, and pleural disease on chest radiographs and HRCT correlated to a similar degree with impairment of lung function.

Adult↗