British Thoracic Society Guideline for pleural disease

Roberts, Mark; Rahman, Najib M.; Maskell, Nick A; Bibby, Anna; Blyth, Kevin G.; Corcoran, John; Edey, Anthony; Evison, Matthew; Fonseka, Duneesha de; Hallifax, Robert; Harden, Susan; Lawrie, Iain; Lim, Eric; McCracken, David J.; Mercer, Rachel; Mishra, Eleanor; Nicholson, Andrew G.; Noorzad, Farinaz; Opstad, Kirstie S.; Parsonage, Maria; Stanton, Andrew; Walker, Steven

doi:10.1136/thorax-2022-219784

Cited by 66 publications

(78 citation statements)

References 62 publications

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“…An overall diagnostic yield of 82% is consistent with reported experiences from tertiary pleural centres 5,6 and only slightly below that which would be expected from thoracoscopic approaches (90-95%). 7,8 Importantly, in those with peripheral lung cancer, full molecular pathology was available in 87%. This yield is comparable to Endobronchial ultrasound-guided tranbronchial needle aspiration (EBUS TBNA), which provides full molecular profiling in 82-96%.…”

Section: Discussionmentioning

confidence: 99%

Physician-led thoracic ultrasound-guided biopsy; a district general hospital perspective

Cafferkey,

Martin

2024

Journal of the Royal College of Physicians of Edinburgh

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Background: Physician-led thoracic ultrasound (TUS)-guided biopsies provide a prompt route to tissue diagnosis in pleural and peripheral lung malignancies. This retrospective study reviews the diagnostic performance and safety of this approach in a UK District General Hospital. Methods: Time to biopsy, diagnostic yield and complication rate were analysed in a cohort of 49 patients undergoing ultrasound-guided tissue sampling between September 2019 and December 2022. Results: Fifty-one TUS-guided biopsies were attempted. Mean time from decision to biopsy was 5 days. The overall diagnostic yield was 82%. Complication rate was low; 3 minor adverse effects were reported which led to no change in routine care. Discussion: This single centre retrospective study shows that physician-led TUS-guided biopsy provides a safe and timely method of obtaining a tissue diagnosis in thoracic malignancy. It offers an alternative to computer tomography (CT)-guided or thoracoscopic biopsies and should be considered in selected patients where local procedural expertise exists.

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Section: Discussionmentioning

confidence: 99%

Physician-led thoracic ultrasound-guided biopsy; a district general hospital perspective

Cafferkey,

Martin

2024

Journal of the Royal College of Physicians of Edinburgh

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“…La terapia antimicrobiana sistémica temprana vendrá acompañada cuando exista infección pleural y deberá ir dirigida al patógeno causal. 12 La resolución quirúrgica del origen de la fístula al espacio pleural está reservada a pacientes en los cuales el manejo establecido no es efectivo o en quienes de manera inmediata se determine por el servicio de cirugía de tórax. 13 Ahora bien, la relación causal entre un procedimiento biliohepático y un biliotórax está bien reconocida en la literatura.…”

Section: Discussionunclassified

Biliotórax: una entidad rara para un diagnóstico frecuente. Un reporte de caso

2023

Respirar

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Introducción: El biliotórax es una condición infrecuente definida por la presencia de bilis en el espacio pleural. Actualmente, hay alrededor de 70 casos descritos en la literatura. Sigue siendo relativamente desconocido, por lo tanto, poco sospechado. Esta entidad suele ser el resultado de una lesión iatrogénica, a menudo secundaria a cirugías o traumatismos del tracto biliar, que conduce a la formación de una fístula pleurobiliar.Caso clínico: Presentamos el caso de un paciente con probable cáncer pulmonar metastásico a pleura e hígado quien por la enfermedad hepática extensa desarrolló biliotórax como complicación.Conclusión: Este caso resalta la importancia de tener un alto grado de sospecha de biliotórax en pacientes que presentan derrame pleural causado por cáncer de pulmón con enfermedad hepática metastásica extensa. Si bien es un diagnóstico raro, el biliotórax puede provocar complicaciones respiratorias y morbilidad significativas.

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“…Foley and Parrish [2 ▪▪ ] explore the available meta-analyses and guidelines which certainly agree that prompt pleural drainage is necessary in empyema but fail to provide objective measures that necessitate surgical intervention (with the exception of bronchopleural fistula, established fibrothorax, and medical treatment failure). The latter of these still lacks guiding metrics, although the BTS guidelines [13 ▪ ] offer persistent sepsis that fails to respond in 5–7 days despite optimal medical management should warrant surgical consideration. Ultimately, there remains wide variability in when and how to progress from tube thoracostomy and this remains a high-impact area for further study.…”

Section: Treatmentmentioning

confidence: 99%

Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Merchant,

Liu

2024

Current Opinion in Pulmonary Medicine

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Purpose of review The aim of this study was to review current key points in the aetiology, diagnosis, treatment, and prevention of empyema thoracis. Early postpandemic trends have seen an increasing global incidence and evolution in the aetiology of empyema. Due to varied aetiology and typically lengthy treatment, empyema will be disproportionately affected by the rising tide of antimicrobial resistance (AMR), thus warranting attention and further research. Recent findings Multiple novel biomarkers (e.g. IL-36γ) are under investigation to aid diagnosis, while oral health assessment tools are now available for prognosticating and risk-stratifying patients with thoracic empyema. There exists an ongoing lack of evidence-based guidance surrounding antibiotic treatment duration, surgical intervention indication, and prognostic scoring utility. Summary Understanding aetiologies in different global regions and settings is pivotal for guiding empirical treatment. Antimicrobial resistance will make thoracic empyema increasingly challenging to treat and should prompt increased awareness of prescribing practices. Novel biomarkers are under investigation which may speed up differentiation of pleural effusion types, allowing faster cohorting of patients. Although newly identified predictors of morbidity and mortality have been suggested to be beneficial for incorporation into clinical practice, further work is required to prognosticate, risk-stratify, and standardize treatment.

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British Thoracic Society Guideline for pleural disease

Cited by 66 publications

References 62 publications

Physician-led thoracic ultrasound-guided biopsy; a district general hospital perspective

Physician-led thoracic ultrasound-guided biopsy; a district general hospital perspective

Biliotórax: una entidad rara para un diagnóstico frecuente. Un reporte de caso

Thoracic empyema: aetiology, diagnosis, treatment, and prevention

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