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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; different medical specialties have been including ultrasonography &#40;US&#41; in their portfolio of services to improve both the yield of the various medical procedures and patient safety&#46; One of the applications most widely taken up has been chest US&#44; and more specifically&#44; chest US for the management of pleural diseases&#44; including both pneumothorax and pleural effusion &#40;PE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> The growing importance of US was demonstrated in a recent study&#44; where the procedure significantly modified the management of 52 &#40;65&#37;&#41; patients by resolving erroneous radiological findings&#44; ruling out pleural disease&#44; and detecting PE not visualized on standard radiography&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> These benefits&#44; along with the growing need to optimize diagnostic and therapeutic procedures in pleural disease&#44; have led to the creation of specialized pleura units which have demonstrated their aptitude for developing and providing training in these techniques&#44; including US&#44; and their suitability as a framework for training specialists and conducting quality clinical research&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this editorial is not to focus on particulars such as the basic concepts&#44; the necessary equipment&#44; or chest US techniques that have been addressed in various review articles&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;5</span></a> but rather to emphasize the main advantages and current indications&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">US has several advantages over conventional radiography and chest computed tomography&#58; it is safe &#40;it uses no ionizing radiation and can be repeated as often as necessary&#41;&#44; transportable &#40;the procedure can be conducted in any part of the hospital&#41;&#44; inexpensive&#44; gives real-time high quality images&#44; and requires a relatively short learning curve&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The current role of US in pleural disease consists of identifying both PE &#40;site&#44; depth&#44; loculation&#44; and septa&#41; and nodules and pleural thickening&#44; and to serve as a guide for diagnostic procedures such as thoracentesis&#44; percutaneous pleural biopsy&#44; pleuroscopy&#44; and chest tubes&#46; US has some obvious advantages in these areas&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Identification of PE&#46; US can identify volumes of pleural fluid &#40;PF&#41; as small as 5<span class="elsevierStyleHsp" style=""></span>ml&#44; although sensitivity improves for volumes of 30<span class="elsevierStyleHsp" style=""></span>ml and more&#46; In a meta-analysis that included 1554 patients&#44; its sensitivity and specificity for detecting PF were 94&#37; and 98&#37;&#44; respectively&#44; which is far superior to radiography &#40;51&#37; and 91&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> It can also differentiate PF patterns according to echogenicity&#44; and calculate PE volume&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> Finally&#44; it can distinguish between subpulmonary effusion&#44; abdominal fluid&#44; and phrenic nerve palsy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0025" class="elsevierStylePara elsevierViewall">US can help define the characteristics of the PF&#44; and as such&#44; orient and determine PE etiology&#46; Infectious PE tend to be hyperechogenic&#44; and loculations and septa can be observed in complicated cases&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> In these cases&#44; complicated PE can also be evacuated promptly&#44; thus improving morbidity and mortality&#46; If pleural or diaphragmatic nodules or thickening greater than 1<span class="elsevierStyleHsp" style=""></span>cm are observed&#44; PE is very probably of malignant origin&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> particularly if it is massive&#46; In certain clinical situations&#44; Kerley B lines can be seen on US&#44; making this procedure highly sensitive and specific for diagnosing a PE of cardiac origin&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Finally&#44; US has also demonstrated its usefulness in the diagnosis of trapped lung&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Utility in the diagnosis of pneumothorax&#46; A systematic review of 21 studies and 1048 patients found that the yield of US for the diagnosis of pneumothorax was much more sensitive than chest X-ray &#40;90&#46;9&#37; &#91;95&#37; CI 86&#46;5&#8211;93&#46;9&#93; vs 50&#46;2&#37; &#91;95&#37; CI 43&#46;5&#8211;57&#93;&#44; respectively&#41;&#44; and similarly specific &#40;98&#46;2&#37; &#91;95&#37; CI 97&#8211;99&#93; vs 99&#46;4&#37; &#91;95&#37; CI 98&#46;3&#8211;99&#46;8&#93;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Identification of puncture site&#46; US helps to select the ideal puncture site&#44; i&#46;e&#46;&#44; the site where the PF has a depth of at least 10<span class="elsevierStyleHsp" style=""></span>mm&#44; where lung is not interposed during maximum inspiration&#44; and where the risk of puncturing other structures is minimal or non-existent&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Increased diagnostic yield of pleural procedures&#46; Many publications have shown that US increases the diagnostic yield of thoracentesis and percutaneous pleural biopsy&#46; In a recent study&#44; US-guided pleural biopsy yield was higher than from blind procedures for the diagnosis of tuberculous PE &#40;88&#46;9&#37; vs 77&#46;8&#37;&#41;&#44; malignant PEs &#40;89&#46;7&#37; vs 31&#37;&#41;&#44; and in all PEs &#40;90&#37; vs 48&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Lower complication rate&#46; US is the examination that has most helped reduce the incidence of pneumothorax&#46; One example is the now classic systematic review of 24 studies including 6605 thoracentesis procedures&#46; The authors showed that US was associated with a lower risk of pneumothorax &#40;odds ratio 0&#46;3&#59; 95&#37; CI 0&#46;2&#8211;0&#46;7&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">In view of the contribution of US to the diagnosis of PE and to reducing complications arising from techniques used to explore PE&#44; this imaging test should be obligatory in the routine practice of all pulmonologists and should be performed before any pleural procedure is undertaken&#46; However&#44; according to the White Paper of the Spanish Society of Pulmonology&#44; only 65&#37; of respiratory medicine departments are equipped to perform chest US&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Pleural US should be an integral feature in centers delivering expert&#44; highly specialized care&#44; such as that provided in dedicated pleura units&#46; This would result in significant benefits&#44; such as reduced hospital stays and shorter times to reach definitive diagnoses&#44; improved patient safety&#44; better training of new specialists in the management of pleural diseases&#44; and expanded clinical research&#46;</p></span>"
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Editorial
The Utility of Ultrasonography in Diseases of the Pleura
Utilidad de la ultrasonografía en la enfermedad pleural
Lucía Ferreiroa,b,
Corresponding author
lferfer7@gmail.com

Corresponding author.
, María E. Toubesa, Luis Valdésa,b
a Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
b Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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        "titulo" => "Utilidad de la ultrasonograf&#237;a en la enfermedad pleural"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; different medical specialties have been including ultrasonography &#40;US&#41; in their portfolio of services to improve both the yield of the various medical procedures and patient safety&#46; One of the applications most widely taken up has been chest US&#44; and more specifically&#44; chest US for the management of pleural diseases&#44; including both pneumothorax and pleural effusion &#40;PE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> The growing importance of US was demonstrated in a recent study&#44; where the procedure significantly modified the management of 52 &#40;65&#37;&#41; patients by resolving erroneous radiological findings&#44; ruling out pleural disease&#44; and detecting PE not visualized on standard radiography&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> These benefits&#44; along with the growing need to optimize diagnostic and therapeutic procedures in pleural disease&#44; have led to the creation of specialized pleura units which have demonstrated their aptitude for developing and providing training in these techniques&#44; including US&#44; and their suitability as a framework for training specialists and conducting quality clinical research&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this editorial is not to focus on particulars such as the basic concepts&#44; the necessary equipment&#44; or chest US techniques that have been addressed in various review articles&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;5</span></a> but rather to emphasize the main advantages and current indications&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">US has several advantages over conventional radiography and chest computed tomography&#58; it is safe &#40;it uses no ionizing radiation and can be repeated as often as necessary&#41;&#44; transportable &#40;the procedure can be conducted in any part of the hospital&#41;&#44; inexpensive&#44; gives real-time high quality images&#44; and requires a relatively short learning curve&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The current role of US in pleural disease consists of identifying both PE &#40;site&#44; depth&#44; loculation&#44; and septa&#41; and nodules and pleural thickening&#44; and to serve as a guide for diagnostic procedures such as thoracentesis&#44; percutaneous pleural biopsy&#44; pleuroscopy&#44; and chest tubes&#46; US has some obvious advantages in these areas&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Identification of PE&#46; US can identify volumes of pleural fluid &#40;PF&#41; as small as 5<span class="elsevierStyleHsp" style=""></span>ml&#44; although sensitivity improves for volumes of 30<span class="elsevierStyleHsp" style=""></span>ml and more&#46; In a meta-analysis that included 1554 patients&#44; its sensitivity and specificity for detecting PF were 94&#37; and 98&#37;&#44; respectively&#44; which is far superior to radiography &#40;51&#37; and 91&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> It can also differentiate PF patterns according to echogenicity&#44; and calculate PE volume&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> Finally&#44; it can distinguish between subpulmonary effusion&#44; abdominal fluid&#44; and phrenic nerve palsy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0025" class="elsevierStylePara elsevierViewall">US can help define the characteristics of the PF&#44; and as such&#44; orient and determine PE etiology&#46; Infectious PE tend to be hyperechogenic&#44; and loculations and septa can be observed in complicated cases&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> In these cases&#44; complicated PE can also be evacuated promptly&#44; thus improving morbidity and mortality&#46; If pleural or diaphragmatic nodules or thickening greater than 1<span class="elsevierStyleHsp" style=""></span>cm are observed&#44; PE is very probably of malignant origin&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> particularly if it is massive&#46; In certain clinical situations&#44; Kerley B lines can be seen on US&#44; making this procedure highly sensitive and specific for diagnosing a PE of cardiac origin&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Finally&#44; US has also demonstrated its usefulness in the diagnosis of trapped lung&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Utility in the diagnosis of pneumothorax&#46; A systematic review of 21 studies and 1048 patients found that the yield of US for the diagnosis of pneumothorax was much more sensitive than chest X-ray &#40;90&#46;9&#37; &#91;95&#37; CI 86&#46;5&#8211;93&#46;9&#93; vs 50&#46;2&#37; &#91;95&#37; CI 43&#46;5&#8211;57&#93;&#44; respectively&#41;&#44; and similarly specific &#40;98&#46;2&#37; &#91;95&#37; CI 97&#8211;99&#93; vs 99&#46;4&#37; &#91;95&#37; CI 98&#46;3&#8211;99&#46;8&#93;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Identification of puncture site&#46; US helps to select the ideal puncture site&#44; i&#46;e&#46;&#44; the site where the PF has a depth of at least 10<span class="elsevierStyleHsp" style=""></span>mm&#44; where lung is not interposed during maximum inspiration&#44; and where the risk of puncturing other structures is minimal or non-existent&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Increased diagnostic yield of pleural procedures&#46; Many publications have shown that US increases the diagnostic yield of thoracentesis and percutaneous pleural biopsy&#46; In a recent study&#44; US-guided pleural biopsy yield was higher than from blind procedures for the diagnosis of tuberculous PE &#40;88&#46;9&#37; vs 77&#46;8&#37;&#41;&#44; malignant PEs &#40;89&#46;7&#37; vs 31&#37;&#41;&#44; and in all PEs &#40;90&#37; vs 48&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Lower complication rate&#46; US is the examination that has most helped reduce the incidence of pneumothorax&#46; One example is the now classic systematic review of 24 studies including 6605 thoracentesis procedures&#46; The authors showed that US was associated with a lower risk of pneumothorax &#40;odds ratio 0&#46;3&#59; 95&#37; CI 0&#46;2&#8211;0&#46;7&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">In view of the contribution of US to the diagnosis of PE and to reducing complications arising from techniques used to explore PE&#44; this imaging test should be obligatory in the routine practice of all pulmonologists and should be performed before any pleural procedure is undertaken&#46; However&#44; according to the White Paper of the Spanish Society of Pulmonology&#44; only 65&#37; of respiratory medicine departments are equipped to perform chest US&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Pleural US should be an integral feature in centers delivering expert&#44; highly specialized care&#44; such as that provided in dedicated pleura units&#46; This would result in significant benefits&#44; such as reduced hospital stays and shorter times to reach definitive diagnoses&#44; improved patient safety&#44; better training of new specialists in the management of pleural diseases&#44; and expanded clinical research&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ferreiro L&#44; Toubes ME&#44; Vald&#233;s L&#46; Utilidad de la ultrasonograf&#237;a en la enfermedad pleural&#46; Arch Bronconeumol&#46; 2017&#59;53&#58;659&#8211;660&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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