Chest
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Programmed death-ligand 1 (PD-L1) testing is feasible in most specimens acquired using endobronchial ultrasound-guided needle aspiration (EBUS-TBNA). ⋯ These findings suggest that PD-L1 results in EBUS-TBNA samples can guide ICI therapy, with treatment outcomes being comparable to those of patients in whom PD-L1 expression was assessed in histological specimens.
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Practice Guideline
Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report.
The purpose of this analysis is to provide evidence-based and consensus-derived guidance for clinicians to improve individual diagnostic decision-making for hypersensitivity pneumonitis (HP) and decrease diagnostic practice variability. ⋯ Diagnosis of HP should employ a patient-centered approach and include a multidisciplinary assessment that incorporates the environmental and occupational exposure history and CT pattern to establish diagnostic confidence prior to considering BAL and/or lung biopsy. Criteria are presented to facilitate diagnosis of HP. Additional research is needed on the performance characteristics and generalizability of exposure assessment tools and traditional and new diagnostic tests in modifying clinical decision-making for HP, particularly among those with a provisional diagnosis.
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Indwelling tunneled pleural catheters (IPCs) are used regularly for recurrent pleural effusion management. Catheter obstruction is not uncommon, often requiring intrapleural medications instillation (ie, alteplase) to restore flow. The safety profile of intrapleural medications has been reported previously; however, most studies exclude anticoagulated patients. ⋯ We report a relatively low incidence of complications and, in particular, bleeding complications in patients receiving intrapleural alteplase for nondraining IPCs. Bleeding episodes occurred in five of 94 patients (5.3%) with no apparent increased risk of bleeding complication, regardless of whether receiving anticoagulation. Additional study is warranted to identify risk factors for complications, in particular bleeding complications, in this patient population.
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Practice Guideline
Executive Summary Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report.
The purpose of this summary is to provide a synopsis of evidence-based and consensus-derived guidance for clinicians to improve individual diagnostic decision-making for hypersensitivity pneumonitis (HP) and decrease diagnostic practice variability. ⋯ Diagnosis of HP should employ a patient-centered approach and include a multidisciplinary assessment that incorporates the environmental and occupational exposure history and CT pattern to establish diagnostic confidence prior to considering BAL and/or lung biopsy. Additional research is needed on the performance characteristics and generalizability of exposure assessment tools and traditional and new diagnostic tests in modifying clinical decision-making for HP, particularly among those with a provisional diagnosis.
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A 29-year-old woman who is a never smoker and has a medical history of systemic hypertension presented with a 3-week history of generalized fatigue and dry cough. She endorsed sicca symptoms of dry eyes and dry mouth. ⋯ She had no known lung disease or history of pneumothorax. Her family history was unremarkable.