Clinics in chest medicine
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Pleuroscopy provides a window to the pleural space while enabling biopsy of the parietal pleura under direct visual guidance for effusions of unknown etiology, guided chest tube placement, and pleurodesis for recurrent pleural effusions or pneumothoraces in selected patients. The procedure enjoyed resurgence when thoracic surgeons introduced the technique for video-assisted thoracic surgery (VATS). VATS is performed under general anesthesia with single-lung ventilation; pleuroscopy is performed in an endoscopy suite using nondisposable rigid or flex-rigid instruments, local anesthesia, and conscious sedation. Pleuroscopy is less invasive; in this review, we discuss the indications, complications, techniques, and recent advances in the procedure.
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Tunneled pleural catheters (TPCs) are a safe, effective, and well-tolerated option for palliation in patients with malignant pleural effusion (MPEs) on an outpatient basis. TPCs are incorporated into international guidelines for the management of MPEs and appear to be the most cost-effective option according to current data.
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This article focuses on thoracoscopy for pleural procedures, both diagnostic and therapeutic, and discusses whether there is a difference between pleuroscopy and thoracoscopy or video-assisted thoracic surgery. How thinking should be structured regarding the management of pleural disease in the modern context of available approaches and interventions is also discussed.
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Clinics in chest medicine · Mar 2013
ReviewThoracentesis and thoracic ultrasound: state of the art in 2013.
Thoracentesis is one of the most common medical procedures performed today. With the advent of thoracic ultrasound, thoracentesis has been enhanced with additional preprocedural, intraprocedural, and postprocedural information. The authors review modern-day thoracentesis and the use of ultrasonography. ⋯ Ultrasound has become an indispensable tool to guide performance of thoracentesis. Ultrasonography for this purpose has several advantages. The authors provide a contemporary review on thoracentesis and the use of ultrasonography.
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Clinics in chest medicine · Mar 2013
ReviewThe evaluation and clinical application of pleural physiology.
Pleural disease is commonly encountered by the chest physician. Evaluation of pleural disease typically begins with thoracentesis and pleural fluid analysis. ⋯ The improved knowledge of pleural physiology can help the clinician in clinical decision making, as well as the diagnosis and treatment of pleural disease. This article reviews pleural physiology and summarizes the relevant data supporting the use of ultrasound and manometry in the evaluation and treatment of pleural disease.