Possible Role of Chest Ultrasound in the Assessment of Costo-Phrenic Angle Lesions Prior to Medical Thoracoscopy: A Retrospective Pilot Case Series

Abstract

Background: Pleural malignancy (PM) and malignant pleural effusion (MPE) represent an increasing burden of diseases. Costo-phrenic angle (CPA) could be involved by malignant small nodularities or thickenings in the case of MPE. The aim of this study was to evaluate whether lung ultrasound (LUS), performed prior to medical thoracoscopy (MT), could detect pleural abnormalities in CPA not easily detectable by chest computed tomography scan (CCT). Methods: Patients suspected for PM and MPE were retrospectively recruited. Patients underwent both LUS examination with a linear array and CCT prior to diagnostic medical thoracoscopy. LUS pathological findings in CPA were compared with pathological findings detected by CCT. Findings were confirmed by subsequent MT, the gold standard for PMs. Results: Twenty-eight patients were recruited. LUS detected 23 cases of pleural abnormalities in CPA. CCT was detected 12 pleural abnormalities. Inter-rater agreement between the two techniques was minimal (Cohen’s Kappa: 0.28). MT detected PMs in CPA in 22 patients. LUS had a sensitivity of 100% and specificity of 83%. CCT had a sensitivity of 54% and specificity of 100%. A better sensitivity for CCT was reached analysing only all abnormalities > 5 mm (64.3%). Conclusions: LUS examination, in the case of PMs, could change and speed up diagnostic workup.

Clinical Effect of Target-Controlled Infusion of Sufentanil and Remifentanil for Internal Thoracoscopy

“…MT can also be used for the removal of foreign bodies in the chest, or by thoracoscopic electrocoagulation, freezing and other techniques. With the development of technology, the therapeutic range of MT will be even broader [13]. For example 1. internal thoracoscopic treatment of malignant pleural effusion; 2. internal thoracoscopic treatment of empyema; 3. internal thoracoscopic treatment of large bubble-related diseases; 4. medical thoracoscopic treatment of tuberculosis coated pleuritis.…”

Lung Ultrasound: A Leading Diagnostic Tool

“…The authors suggest that dialysis units adopt LUS in their daily clinical practice as a bedside tool not only for fluid status assessment and dry weight prescription but also to prevent intradialytic hypotension and drive ultrafiltration prescription during the whole hemodialytic session. The authors of [4] show how US offers good sensitivity in the detection of pleural abnormalities localized in the costo-phrenic angle (CPA) and how an accurate ultrasound examination of CPA in patients affected by pleural effusion or suspected malignant pleural effusion could assess even millimetric pathological lesions not easily detectable by chest CT scan. In [5], the role of ultrasound in the diagnosis of pulmonary infection, caused by intracellular fungal pathogens or mycobacteria, is analyzed through a systematic review.…”