Seminars in respiratory and critical care medicine
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Ultrasonography of the thorax has become a more recognized tool in pulmonary medicine, thanks to continuing clinical research that has proven its many valuable roles in the day-to-day management of pulmonary and pleural diseases. Ultrasound examination is a cost-effective imaging modality that permits the pulmonologist to obtain information about the pathologies in the thorax without the risk of exposure to ionizing radiation, providing the examiner with real-time and immediate results. Its ease of use and training along with its portability to the patient's bedside and accurate examination of the pleural space has allowed for safer pleural procedures such as thoracentesis, chest tube placement, tunneled pleural catheter placement, and medical thoracoscopy. In this review, we summarize the technique of chest ultrasonography, compare ultrasound to other frequently used thoracic imaging modalities, and focus on its use in obtaining pleural access while performing invasive pleural procedures.
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The field of interventional pulmonology (IP) is a rapidly growing subspecialty of pulmonary and critical care medicine (PCCM), primarily focused on the evaluation and management of patients with lung nodules, masses, mediastinal and hilar adenopathy, central airway obstruction, and pleural disease. Traditionally passed on in the apprenticeship model, dedicated fellowships began in the early 2000s and there are currently approximately 24 IP fellowships throughout the United States. In addition to the evaluation and management of patients with the above diseases, the additional year provides training in advanced diagnostic and minimally invasive therapeutic procedures that are not specifically taught during a standard PCCM fellowship. This article will review the evolution of the field of IP as well as the pathways to learn advanced procedural techniques.
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Semin Respir Crit Care Med · Dec 2014
ReviewCurrent controversies in the management of malignant pleural effusions.
Malignant pleural effusion (MPE) can complicate most malignancies and is a common clinical problem presenting to respiratory and cancer care physicians. Despite its frequent occurrence, current knowledge of MPE remains limited and controversy surrounds almost every aspect in its diagnosis and management. A lack of robust data has led to significant practice variations worldwide, inefficiencies in healthcare provision, and threats to patient safety. ⋯ Strategies combining pleurodesis and IPC are being studied. MPE consists of a heterogenous group of diseases and careful phenotyping of malignant effusion patients can provide important clinical information that will advance the field and allow better stratification of patients and planning of therapy accordingly. This review addresses the controversies in MPE diagnosis and management and exposes the deficits in knowledge of MPE that should be the focus of future research.
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Semin Respir Crit Care Med · Dec 2014
ReviewInterventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction.
Emphysema and asthma are responsible for economic and social burden. Altering the natural course of these diseases is a field of intense research. The National Emphysema Treatment Trial showed that lung volume reduction surgery (LVRS) could significantly reduce both morbidity and mortality in properly selected patients. ⋯ In patients suffering from asthma who cannot achieve control with standard medical care, BT has been shown to be safe and improves symptoms, with long lasting benefit. BT does not seem to affect traditional markers of asthma severity such as forced expiratory volume in 1 second and questions remain regarding proper patient selection for this therapy and its true physiologic effects. This article is a review of bronchoscopic modalities for emphysema and asthma.