Editorial
The Utility of Ultrasonography in Diseases of the Pleura
Utilidad de la ultrasonografía en la enfermedad pleural
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Toubes, Luis Valdés" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Lucía" "apellidos" => "Ferreiro" "email" => array:1 [ 0 => "lferfer7@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María E." "apellidos" => "Toubes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Luis" "apellidos" => "Valdés" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ultrasonografía en la enfermedad pleural" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years, different medical specialties have been including ultrasonography (US) in their portfolio of services to improve both the yield of the various medical procedures and patient safety. One of the applications most widely taken up has been chest US, and more specifically, chest US for the management of pleural diseases, including both pneumothorax and pleural effusion (PE).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> The growing importance of US was demonstrated in a recent study, where the procedure significantly modified the management of 52 (65%) patients by resolving erroneous radiological findings, ruling out pleural disease, and detecting PE not visualized on standard radiography.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> These benefits, along with the growing need to optimize diagnostic and therapeutic procedures in pleural disease, have led to the creation of specialized pleura units which have demonstrated their aptitude for developing and providing training in these techniques, including US, and their suitability as a framework for training specialists and conducting quality clinical research.<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, the necessary equipment, or chest US techniques that have been addressed in various review articles,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,5</span></a> but rather to emphasize the main advantages and current indications.</p><p id="par0015" class="elsevierStylePara elsevierViewall">US has several advantages over conventional radiography and chest computed tomography: it is safe (it uses no ionizing radiation and can be repeated as often as necessary), transportable (the procedure can be conducted in any part of the hospital), inexpensive, gives real-time high quality images, and requires a relatively short learning curve.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> The current role of US in pleural disease consists of identifying both PE (site, depth, loculation, and septa) and nodules and pleural thickening, and to serve as a guide for diagnostic procedures such as thoracentesis, percutaneous pleural biopsy, pleuroscopy, and chest tubes. US has some obvious advantages in these areas.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Identification of PE. US can identify volumes of pleural fluid (PF) as small as 5<span class="elsevierStyleHsp" style=""></span>ml, although sensitivity improves for volumes of 30<span class="elsevierStyleHsp" style=""></span>ml and more. In a meta-analysis that included 1554 patients, its sensitivity and specificity for detecting PF were 94% and 98%, respectively, which is far superior to radiography (51% and 91%, respectively).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> It can also differentiate PF patterns according to echogenicity, and calculate PE volume.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> Finally, it can distinguish between subpulmonary effusion, abdominal fluid, and phrenic nerve palsy.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0025" class="elsevierStylePara elsevierViewall">US can help define the characteristics of the PF, and as such, orient and determine PE etiology. Infectious PE tend to be hyperechogenic, and loculations and septa can be observed in complicated cases.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> In these cases, complicated PE can also be evacuated promptly, thus improving morbidity and mortality. If pleural or diaphragmatic nodules or thickening greater than 1<span class="elsevierStyleHsp" style=""></span>cm are observed, PE is very probably of malignant origin,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> particularly if it is massive. In certain clinical situations, Kerley B lines can be seen on US, making this procedure highly sensitive and specific for diagnosing a PE of cardiac origin.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> Finally, US has also demonstrated its usefulness in the diagnosis of trapped lung.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Utility in the diagnosis of pneumothorax. 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 (90.9% [95% CI 86.5–93.9] vs 50.2% [95% CI 43.5–57], respectively), and similarly specific (98.2% [95% CI 97–99] vs 99.4% [95% CI 98.3–99.8], respectively).<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Identification of puncture site. US helps to select the ideal puncture site, i.e., the site where the PF has a depth of at least 10<span class="elsevierStyleHsp" style=""></span>mm, where lung is not interposed during maximum inspiration, and where the risk of puncturing other structures is minimal or non-existent.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Increased diagnostic yield of pleural procedures. Many publications have shown that US increases the diagnostic yield of thoracentesis and percutaneous pleural biopsy. In a recent study, US-guided pleural biopsy yield was higher than from blind procedures for the diagnosis of tuberculous PE (88.9% vs 77.8%), malignant PEs (89.7% vs 31%), and in all PEs (90% vs 48%).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Lower complication rate. US is the examination that has most helped reduce the incidence of pneumothorax. One example is the now classic systematic review of 24 studies including 6605 thoracentesis procedures. The authors showed that US was associated with a lower risk of pneumothorax (odds ratio 0.3; 95% CI 0.2–0.7).<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, this imaging test should be obligatory in the routine practice of all pulmonologists and should be performed before any pleural procedure is undertaken. However, according to the White Paper of the Spanish Society of Pulmonology, only 65% of respiratory medicine departments are equipped to perform chest US.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Pleural US should be an integral feature in centers delivering expert, highly specialized care, such as that provided in dedicated pleura units. This would result in significant benefits, such as reduced hospital stays and shorter times to reach definitive diagnoses, improved patient safety, better training of new specialists in the management of pleural diseases, and expanded clinical research.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferreiro L, Toubes ME, Valdés L. Utilidad de la ultrasonografía en la enfermedad pleural. Arch Bronconeumol. 2017;53:659–660.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic accuracy, safety and utilisation of respiratory physician-delivered thoracic ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.M. Rahman" 1 => "A. Singanayagam" 2 => "H.E. Davies" 3 => "J.M. Wrightson" 4 => "E.K. Mishra" 5 => "Y.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 35 | 26 | 61 |
| 2024 September | 41 | 14 | 55 |
| 2024 August | 63 | 42 | 105 |
| 2024 July | 46 | 21 | 67 |
| 2024 June | 49 | 22 | 71 |
| 2024 May | 85 | 28 | 113 |
| 2024 April | 41 | 30 | 71 |
| 2024 March | 48 | 25 | 73 |
| 2024 February | 35 | 23 | 58 |
| 2023 March | 19 | 3 | 22 |
| 2023 February | 51 | 18 | 69 |
| 2023 January | 18 | 25 | 43 |
| 2022 December | 50 | 28 | 78 |
| 2022 November | 68 | 20 | 88 |
| 2022 October | 48 | 43 | 91 |
| 2022 September | 34 | 33 | 67 |
| 2022 August | 31 | 43 | 74 |
| 2022 July | 38 | 35 | 73 |
| 2022 June | 18 | 33 | 51 |
| 2022 May | 31 | 27 | 58 |
| 2022 April | 26 | 32 | 58 |
| 2022 March | 33 | 43 | 76 |
| 2022 February | 28 | 21 | 49 |
| 2022 January | 35 | 33 | 68 |
| 2021 December | 32 | 54 | 86 |
| 2021 November | 25 | 30 | 55 |
| 2021 October | 51 | 37 | 88 |
| 2021 September | 27 | 27 | 54 |
| 2021 August | 22 | 36 | 58 |
| 2021 July | 38 | 31 | 69 |
| 2021 June | 38 | 51 | 89 |
| 2021 May | 31 | 45 | 76 |
| 2021 April | 73 | 78 | 151 |
| 2021 March | 37 | 21 | 58 |
| 2021 February | 30 | 20 | 50 |
| 2021 January | 32 | 14 | 46 |
| 2020 December | 30 | 15 | 45 |
| 2020 November | 31 | 10 | 41 |
| 2020 October | 32 | 9 | 41 |
| 2020 September | 13 | 4 | 17 |
| 2020 August | 30 | 14 | 44 |
| 2020 July | 37 | 29 | 66 |
| 2020 June | 25 | 12 | 37 |
| 2020 May | 31 | 11 | 42 |
| 2020 April | 44 | 22 | 66 |
| 2020 March | 22 | 9 | 31 |
| 2020 February | 36 | 18 | 54 |
| 2020 January | 33 | 19 | 52 |
| 2019 December | 56 | 17 | 73 |
| 2019 November | 37 | 23 | 60 |
| 2019 October | 21 | 14 | 35 |
| 2019 September | 16 | 13 | 29 |
| 2019 August | 35 | 18 | 53 |
| 2019 July | 25 | 16 | 41 |
| 2019 June | 18 | 7 | 25 |
| 2019 May | 23 | 13 | 36 |
| 2019 April | 33 | 11 | 44 |
| 2019 March | 28 | 21 | 49 |
| 2019 February | 31 | 25 | 56 |
| 2019 January | 59 | 27 | 86 |
| 2018 December | 40 | 27 | 67 |
| 2018 November | 98 | 33 | 131 |
| 2018 October | 121 | 27 | 148 |
| 2018 September | 52 | 10 | 62 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 20 | 13 | 33 |
| 2018 March | 35 | 15 | 50 |
| 2018 January | 1 | 0 | 1 |
| 2017 December | 0 | 1 | 1 |
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