Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Aug 2008
ReviewUltrasound-guided endobronchial, endoscopic, and transthoracic biopsy.
Advances in ultrasound technology coupled with reduced costs have provided the chest physician with novel approaches for evaluating lung and pleural diseases. This review examines the evidence for the use of three ultrasonic techniques pertinent to pulmonary disease: endobronchial ultrasound, endoscopic ultrasound, and transthoracic ultrasound.
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Semin Respir Crit Care Med · Aug 2008
ReviewPleural interventions: management of acute and chronic pneumothorax.
Pneumothorax is a common clinical entity that may present to a wide variety of medical specialties. Primary pneumothorax (in the presence of no known underlying lung disease) and secondary pneumothorax (in known lung disease) are distinct entities with varied etiology, treatment, and prognosis. ⋯ The etiology of pneumothorax will often inform the clinician whether a more conservative or more invasive approach is required. Radiological intervention techniques are valuable in the treatment of complicated pneumothoraces and in certain clinical situations.
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Malignant pleural effusions (MPEs) are commonly seen as complications of advanced malignancy, especially in lung cancer and breast cancer. The management will depend on the performance status of the patient, severity of the symptoms, and the primary tumor's response to systemic therapy. Thoracentesis is usually the first step for both diagnostic and therapeutic reasons. ⋯ Additional advantages are the ability to treat trapped lung, large loculated effusions, and bilateral effusions simultaneously, as well as lower charges. Spontaneous pleurodesis can occur in up to 50% of the patients. Tunneled catheters should be considered in all patients with MPE and particularly those who have a reasonable expectancy of being outpatient.