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Pleural Conditions

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Thoracic Ultrasound and Integrated Imaging

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Abstract

The ultrasound study of pleural pathology requires an understanding of semeiotics and usual finds.

This imaging method allows the identification, evaluation, and control of pleural effusion and pleural empyema; it can guide transthoracic drainage manoeuvres.

Thoracic ultrasound allows the diagnosis and the extension balance of pneumothorax.

Finally, being able to demonstrate some of the conditions related to exposure to asbestos, such as pleural plaques and round atelectasis, thoracic ultrasound may play a role in the follow-up of subjects exposed to asbestos.

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References

  1. Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995;108(5):1345–8.

    Article  CAS  PubMed  Google Scholar 

  2. Lichtenstein D, Mezière G. Relevance of lung ultrasound in the diagnosis of acute respiratory failure. Chest. 2008;134:117–25.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sasso A. Fisica degli ultrasuoni. In: Bazzocchi M, et al., editors. Ecografia. Napoli: Idelson-Gnocchi; 2002. p. 3–17.

    Google Scholar 

  4. Soldati G, Copetti R. Ecografia toracica. Torino: C.G. Edizioni Medico Scientifiche; 2006.

    Google Scholar 

  5. Müller NL. Imaging of the pleura. Radiology. 1993;186(2):297–309.

    Article  PubMed  Google Scholar 

  6. Pistolesi M, Miniati M, Giuntini C. Pleural liquid and solute exchange. Am Rev Respir Dis. 1989;140:825–47.

    Article  CAS  PubMed  Google Scholar 

  7. Fabbri M. Cooperativa Libraria Universitaria Editrice Bologna CLUEB Malattie dell’Apparato Respiratorio; 2003. p. 137–8.

    Google Scholar 

  8. Allen SJ, Laine GA, Drake RE, Gabel JC. Superior vena caval pressure elevation causes pleural effusion formation in sheep. Am J Phys. 1988;255:492–5.

    Google Scholar 

  9. Eid AA, Keddissi JI, Kinasewitz GT. Hypoalbuminemia as a cause of pleural effusions. Chest. 1999;115:1066–9.

    Article  CAS  PubMed  Google Scholar 

  10. McLoud TC, Flower CD. Imaging the pleura: sonography, CT, and MR imaging. AJR Am J Roentgenol. 1991;156:1145–53.

    Article  CAS  PubMed  Google Scholar 

  11. Lichtenstein D. Lung ultrasound in the critically ill. Clin Intensive Care. Chest. 2005;16:79–87.

    Article  Google Scholar 

  12. Wu RG, Yuan A, Liaw YS, et al. Image comparison of real-time gray-scale ultrasound and color Doppler ultrasound for use in diagnosis of minimal pleural effusion. Am J Respir Crit Care Med. 1994;150(2):510–414.

    Article  CAS  PubMed  Google Scholar 

  13. Wu RG, Yang PC, Kuo SH, Luh KT. “Fluid color” sign: a useful indicator for discrimination between pleural thickening and pleural effusion. J Ultrasound Med. 1995;14:767–9.

    Article  CAS  PubMed  Google Scholar 

  14. Light RW, Macgregor MI, Luchsinger PC, et al. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77:507–13.

    Article  CAS  PubMed  Google Scholar 

  15. Burges LJ, Maritz FJ, Taljaard JJ. Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates. Chest. 1995;107:1604–9.

    Article  Google Scholar 

  16. Light RW. Pleural effusion. N Engl J Med. 2002;346:1971–7.

    Article  PubMed  Google Scholar 

  17. Porcel JM. Pleural fluid biomarkers: beyond the Light criteria. Clin Chest Med. 2013;34(1):27–37.

    Article  PubMed  Google Scholar 

  18. Light RW. The Light criteria: the beginning and why they are useful 40 years later. Clin Chest Med. 2013;34(1):21–6.

    Article  PubMed  Google Scholar 

  19. Piccoli M, Trambaiolo P, Salustri A, et al. Bedside diagnosis and follow-up of patients with pleural effusion by a hand-carried ultrasound device early after cardiac surgery. Chest. 2005;128:3413–20.

    Article  PubMed  Google Scholar 

  20. Gryminski J, Krakowka, Lypacewicz G. The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest. 1976;70:33–7.

    Article  CAS  PubMed  Google Scholar 

  21. Felson B. Chest roentgenology. Philadelphia: WB Saunders; 1973. p. 361.

    Google Scholar 

  22. Moskowitz H, Platt RT, Schachar R, Mellins H. Roentgen visualization of minute pleural effusion. An experimental study to determine the minimum amount of pleural fluid visible on a radiograph. Radiology. 1973;109:33.

    Article  CAS  PubMed  Google Scholar 

  23. Gardelli G, Feletti F, Nanni A, et al. Chest ultrasonography in the ICU. Respir Care. 2012;57(5):773–81.

    Article  PubMed  Google Scholar 

  24. Battista G, Ghigi G, Zompatori M, Salizzoni E, Canini R. Torace. In: Bazzocchi M, et al., editors. Ecografia. Napoli: Idelson-Gnocchi; 2002. p. 297–318.

    Google Scholar 

  25. Eibenberger WI, Dock ME, Ammann, et al. Quantification of pleural effusion: sonography versus radiography. Radiology. 1994;191(3):681–4.

    Article  CAS  PubMed  Google Scholar 

  26. Vignon P, Chastagner C, Berkane V. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med. 2005;33:1757–63.

    Article  PubMed  Google Scholar 

  27. Krackov R, Rizzolo D. Real-time ultrasound-guided thoracentesis. JAAPA. 2017 Apr;30(4):32–7. https://doi.org/10.1097/01.JAA.0000508210.40675.09.

    Article  PubMed  Google Scholar 

  28. Beckh S, Bölcskei PL, Lessnau KD. Real-time chest ultrasonography a comprehensive review for the pulmonologist. Chest. 2002;122:1759–73.

    Article  PubMed  Google Scholar 

  29. Roch A, Bojan M, Michelet P, et al. Usefulness of ultrasonography in predicting pleural effusions >500 mL in patients receiving mechanical ventilation. Chest. 2005;127:224–32.

    Article  PubMed  Google Scholar 

  30. Goecke W, Schwerk WB. Chapter 12: Die Real-Time Sonographie in der Diagnostik von Pleuraergüssen. In: Gebhardt J, et al., editors. Ultraschalldiagnostik, vol. 89. Berlin: Springer; 1990. p. 385–7.

    Google Scholar 

  31. Reuss J. Sonographic imaging of the pleura: nearly 30 years experience. Eur J Ultrasound. 1996;3:125–39.

    Article  Google Scholar 

  32. Yu CJ, Yang PC, Chang DB, Luh KT. Diagnostic and therapeutic use of chest sonography: value in critically ill patients. Am J Roentgenol. 1992;159:695–701.

    Article  CAS  Google Scholar 

  33. Izumi S, Tamaki S, Natori H, Kira S. Ultrasonically guided aspiration needle biopsy in diseases of the chest. Am Rev Respir Dis. 1982;125:460–4.

    CAS  PubMed  Google Scholar 

  34. Diacon AH, Theron J, Schuurmans MM, et al. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med. 2004;170:49–53.

    Article  PubMed  Google Scholar 

  35. Davies RJ, Traill ZC, Gleeson FV. Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection. Thorax. 1997;52:416–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Bouros D, Schiza S, Tzanakis N, et al. Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema: a randomized, double-blind study. Am J Respir Crit Care Med. 1999;159:37–42.

    Article  CAS  PubMed  Google Scholar 

  37. Maskell NA, Davies CW, Nunn AJ, et al. U.K. controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352:865–74.

    Article  CAS  PubMed  Google Scholar 

  38. Cameron R, Davies HR. Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev. 2008;(2):1.

    Google Scholar 

  39. Nie W, Liu Y, Ye J, Shi L, Shao F, Ying K, Zhang R. Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials. Clin Respir J. 2014;8(3):281–91.

    Article  CAS  PubMed  Google Scholar 

  40. Alemán C, Porcel JM, Alegre J, Ruiz E, Bielsa S, Andreu J, Deu M, Suñé P, Martínez-Sogués M, López I, Pallisa E, Schoenenberger JA, Bruno Montoro J, de Sevilla TF. Intrapleural fibrinolysis with urokinase versus alteplase in complicated parapneumonic pleural effusions and empyemas: a prospective randomized study. Lung. 2015;193(6):993–1000.

    Article  PubMed  CAS  Google Scholar 

  41. Cha LM, Choi S, Kim T, Yoon SW. Intrapleural urokinase therapy in a neonate with pleural empyema. Pediatr Int. 2016;58(7):616–9.

    Article  PubMed  Google Scholar 

  42. Gehmacher O, Kopf A, Scheier M. Can pleurisy be detected with ultrasound? Ultraschall Med. 1997;18(5):214–9.

    Article  CAS  PubMed  Google Scholar 

  43. Görg C, Bert T, Görg K. Contrast-enhanced sonography for differential diagnosis of pleurisy and focal pleural lesions of unknown cause. Chest. 2005;128(6):3894–9.

    Article  PubMed  Google Scholar 

  44. Holzapfel L, Demingeon G, Benarbia S, et al. Diagnostic du pneumothorax chez le malade presentant une insuffisance respiratoire aigue. Rean Soins Intens Med Urg. 1990;6:38–41.

    Google Scholar 

  45. Gordon R. The deep sulcus sign. Radiology. 1980;136:25–7.

    Article  CAS  PubMed  Google Scholar 

  46. Soldati G, Testa A, Sher S, et al. Occult traumatic pneumothorax: accuracy of lung ultrasonography in the emergency department. Chest. 2008;133:204–11.

    Article  PubMed  Google Scholar 

  47. Oveland NP. Lung point: Response. Chest. 2013; 143(6):1838–9.

    Article  PubMed  Google Scholar 

  48. Feletti F, Mucci V, Aliverti A. Chest ultrasonography in modern day extreme settings: From military setting and natural disasters to space flights and extreme sports. Can Respir J. 2018 Mar 15;2018:8739704. https://doi.org/10.1155/2018/8739704.

    Article  Google Scholar 

  49. Yang H, Testa JR, Carbone M. Mesothelioma epidemiology, carcinogenesis, and pathogenesis. Curr Treat Options in Oncol. 2008;9:147–57.

    Article  Google Scholar 

  50. Wechsler RJ, Steiner RM, Conant EF. Occupationally induced neoplasm of the lung and pleura. Radiol Clin N Am. 1992;30:1245–68.

    CAS  PubMed  Google Scholar 

  51. Koh DM, Burke S, Davies N, Padley SP. Transthoracic US of the chest: clinical uses and applications. Radiographics. 2002;22(1):1.

    Article  Google Scholar 

  52. Marchbank ND, Wilson AG, Joseph AE. Ultrasound features of folded lung. Clin Radiol. 1996;51(6):433–7.

    Article  CAS  PubMed  Google Scholar 

  53. Husain AN, Colby T. Guidelines for pathologic diagnosis of malignant mesothelioma. Arch Pathol Lab Med. 2013;137:647–67.

    Article  PubMed  Google Scholar 

  54. Patel SC, Dowell JE. Modern management of malignant pleural mesothelioma. Lung Cancer (Auckl). 2016;7:63–72.

    Google Scholar 

  55. Boutin C, Rey F. Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Cancer. 1993;72(2):389–93.

    Article  CAS  PubMed  Google Scholar 

  56. Loddenkemper R. Thoracoscopy—state of the art. Eur Respir J. 1998;11:213–21.

    Article  CAS  PubMed  Google Scholar 

  57. Metintas M, Ak G, Dundar E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions. Chest. 2010;137(6):1362–8.

    Article  PubMed  Google Scholar 

  58. Adams RF, Gray W, Davies RJ, Gleeson FV. Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. Chest. 2001;120(6):1798–802.

    Article  CAS  PubMed  Google Scholar 

  59. American Thoracic Society. Diagnosis and initial management of nonmalignant diseases related to asbestos. Am J Respir Crit Care Med. 2004;170:691–715.

    Article  Google Scholar 

  60. Cugell DW, Kamp DW. Asbestos and the pleura. A review. Chest. 2004;125:1103–17.

    Article  PubMed  Google Scholar 

  61. Hosoda Y, Hiraga Y, Sasagawa S. Railways and asbestos in Japan (1928-1987)-epidemiology of pleural plaques, malignancies and pneumoconioses. J Occup Health. 2008;50(4):297–307.

    Article  CAS  PubMed  Google Scholar 

  62. Lichtenstein D, Mézière G, Biderman P, et al. The comet-tail artifact an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;156:1640–6.

    Article  CAS  PubMed  Google Scholar 

  63. Smargiassi A, Pasciuto G, Pedicelli I, et al. Chest ultrasonography in health surveillance of asbestos-related lung diseases. Toxicol Ind Health. 2017;33(6):537–46. 748233716686916.

    Article  CAS  PubMed  Google Scholar 

  64. Yang PC, Luh KT, Chang DB, et al. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. Am J Roentgenol. 1992;159(1):29–33.

    Article  CAS  Google Scholar 

  65. Reuss J. Sonographic imaging of the pleura: nearly 30 years experience. Eur J Ultrasound. 1996;3:25–39.

    Article  Google Scholar 

  66. Steinberg HV, Erwin BC. Metastases to the pleura: sonographic detection. J Clin Ultrasound. 1987;15:276–9.

    Article  CAS  PubMed  Google Scholar 

  67. Goerg C, Schwerk WB, Goerg K, et al. Pleural effusion: an “acoustic window” for sonography of pleural metastases. J Clin Ultrasound. 1991;19:93–7.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Ausl della Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy

    Francesco Feletti

  2. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy

    Francesco Feletti & Andrea Aliverti

  3. Dipartimento di Diagnostica per Immagini, Ausl di Ferrara, Ospedale Universitario di Ferrara, Ferrara, Italy

    Bruna Malta

Authors
  1. Francesco Feletti
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  2. Bruna Malta
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  3. Andrea Aliverti
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Corresponding author

Correspondence to Francesco Feletti .

Editor information

Editors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Ausl della Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy

    Francesco Feletti

  2. Dipartimento di Diagnostica per Immagini, Ausl di Ferrara, Ospedale Universitario di Ferrara, Ferrara, Italy

    Bruna Malta

  3. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy

    Andrea Aliverti

1 Electronic Supplementary Material

Lung sliding. Physiological sliding of the two pleural sheets during respiratory movements (MOV 112394 kb)

The fluid colou r sign highlights small pleural effusions (MOV 144868 kb)

Simultaneous visualisation of pleural effusion and parenchymal consolidation with aerial bronchogram (MOV 99600 kb)

The video shows the appearance of the lung point in intercostal and longitudinal scans in the case shown in Fig. 6.11 (MOV 181788 kb)

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Feletti, F., Malta, B., Aliverti, A. (2020). Pleural Conditions. In: Feletti, F., Malta, B., Aliverti, A. (eds) Thoracic Ultrasound and Integrated Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-93055-8_6

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  • DOI: https://doi.org/10.1007/978-3-319-93055-8_6

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