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Panminerva Medica 2019 September;61(3):326-43

DOI: 10.23736/S0031-0808.18.03564-4


lingua: Inglese

Competence in pleural procedures

Paolo CARLUCCI 1 , Marco TRIGIANI 2, Pier A. MORI 3, Michele MONDONI 1, Valentina PINELLI 4, Angelo G. CASALINI 3, Emanuele G. CONTE 5, Giuseppe BUGGIO 6, Liliana VILLARI 7, Giampietro MARCHETTI 8

1 Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy; 2 SOD Pneumologia Interventistica AOUC, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; 3 Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Parma, Italy; 4 Division of Pneumology, Ospedale San Bartolomeo, Sarzana, La Spezia, Italy; 5 Division of Pneumology, “C. e G. Mazzoni” Hospital, Ascoli Piceno, Italy; 6 Department of Pneumology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy; 7 Division of Pneumology, AUSL Toscana Nord-Ovest, Apuane Hospital, Massa, Italy; 8 Division of Pneumology, Spedali Civili di Brescia, Brescia, Italy

Diseases of the pleura and pleural space are common and present a significant contribution to the workload of respiratory physicians, with most cases resulting from congestive heart failure, pneumonia, and cancer. Although the radiographic and ultrasonographic detection of pleural abnormalities may be obvious, the determination of a specific diagnosis can often represent a challenge. Invasive procedures such as pleural drainage, ultrasound/CT-guided pleural biopsy or medical thoracoscopy can be useful in determining specific diagnosis of pleural diseases.
Management of primary and secondary spontaneous pneumothorax is mandatory in an interventional pulmonology training program, while the medical or surgical treatment of the recurrence is still a matter of discussion. Pleural drainage is a diagnostic and therapeutic procedure used in the treatment of pneumothorax and pleural effusions of different etiologies and even in palliation of symptomatic in malignant pleural effusion. Medical thoracoscopy (MT) is a minimally invasive procedure aimed at inspecting the pleural space. It could be a diagnostic procedure in pleural effusions (suspected malignant pleural effusion, infective pleural disease such as empyema or tuberculosis) or therapeutic procedure (chemical pleurodesis or opening of loculation in empyema). Diagnostic yield is 95% in patients with pleural malignancies and higher in pleural tuberculosis. In parapneumonic complex effusion, MT obviates the need for surgery in most cases. Thoracoscopy training should be considered being as important as bronchoscopy training for interventional pulmonology, although prior acquisition of ultrasonography and chest tube insertion skills is essential.

KEY WORDS: Ultrasonography - Pleural effusion - Pneumothorax - Pleurodesis

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