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Solitary pulmonary nodules (SPNs) measuring 8 to 30 mm in diameter require further workup to determine the likelihood of malignancy. What is the diagnostic performance of a lung cancer prediction convolutional neural network (LCP-CNN) in SPNs using unenhanced and contrast-enhanced CT imaging compared with the current clinical workup? This was a post hoc analysis of the Single Pulmonary Nodule Investigation: Accuracy and Cost-Effectiveness of Dynamic Contrast Enhanced Computed Tomography in the Characterisation of Solitary Pulmonary Nodules trial, a prospective multicenter study comparing the diagnostic accuracy of dynamic contrast-enhanced (DCE) CT imaging with PET imaging in SPNs. The LCP-CNN was designed and validated in an external cohort. LCP-CNN-generated risk scores were created from the noncontrast and contrast-enhanced CT scan images from the DCE CT imaging. The gold standard was histologic analysis or 2 years of follow-up. The area under the receiver operating characteristic curves (AUC) were calculated using LCP-CNN score, maximum standardized uptake value, and DCE CT scan maximum enhancement and were compared using the DeLong test. Two hundred seventy participants (mean ± SD age, 68.3 ± 8.8 years; 49% women) underwent PET with CT scan imaging and DCE CT imaging with CT scan data available centrally for LCP-CNN analysis. The accuracy of the LCP-CNN on the noncontrast images (AUC, 0.83; 95% CI, 0.79-0.88) was superior to that of DCE CT imaging (AUC, 0.76; 95% CI, 0.69-0.82; P =.03) and equal to that of PET with CT scan imaging (AUC, 0.86; 95% CI, 0.81-0.90; P =.35). The presence of contrast resulted in a small reduction in diagnostic accuracy, with the AUC falling from 0.83 (95% CI, 0.79-0.88) on the noncontrast images to 0.80 to 0.83 after contrast (P <.05 for 240 s after contrast only). An LCP-CNN algorithm provides an AUC equivalent to PET with CT scan imaging in the diagnosis of solitary pulmonary nodules. ClinicalTrials.gov Identifier; No.: NCT02013063 [ABSTRACT FROM AUTHOR]

The article discusses a retrospective study that estimated the diagnostic yield of all ultrasound-guided pleural biopsies performed by physicians at the Oxford Center for Respiratory Medicine between 2010 and 2013, which included those biopsies conducted after "failed" thorascopy. It reports that 97% of all biopsies carried out during this period obtained sufficient pleural tissue for histological analysis, while 26% of all collected biopsy specimens showed pleural malignancy on histology.

The article presents a study which describes the development of a validated clinical risk score to identify those at risk for poor outcome at presentation in patients with pleural infection. The authors called the scoring system RAPID (renal, age, purulence, infection source and dietary factors). The risk stratification of patients with pleural infection at presentation permitted by the RAPID score is highlighted.

The article presents a study to define the position and variability of the intercostal artery within the intercostal space and its relationship to the adjacent ribs using computed tomography (CT) scan angiography and continuous analysis techniques. The study involved the analysis of 298 arteries from 47 patients. It finds that exposed artery length was not associated with age, sex, rib space or side. The variability of arterial position was found to be associated with age and rib space number.

The article focuses on the study which examines the relationship between the sizes of the chest tubes and outcomes in patients with pleural infection. The study states that the clinical outcomes is similar in patients treated with different chest tube sizes for pleural infection but smaller-size tubes cause less pain. It mentions that smaller size tubes is said to be the initial treatment for pleural infection.

The article presents information on a study which determines the diagnostic accuracy of ultrasound in the diagnosis of pneumothorax in patients with chronic obstructive pulmonary disease (COPD) with particular regard to false-positive diagnoses. The study reported a false-positive diagnosis in a patient with bullous emphysema. The study findings suggest that patients with COPD commonly show signs of ultrasound mimicking in a pneumothorax, but this was not seen in patients with cystic fibrosis. According to many medical personal, a large study of trauma patients excluded those with preexisting lung disease.

Study Objectives: Pleural fluid cytology and non-image-guided Abrams or Cope biopsies have sensitivities of approximately 30% for detecting malignant mesothelioma, and thoracoscopic biopsy has a sensitivity of approximately 90%. The difference between these two probably relates to obtaining adequate tissue. The use of immunohistochemical stains allows a firm diagnosis to be made from relatively small samples. This study explores whether percutaneous image-guided cutting needle biopsy (CNB) combined with immunohistochemistry is accurate in diagnosing pleural thickening due to mesothelioma.Design: Retrospective review of image-guided CNB of pleural thickening performed on consecutive patients over 7 years by a single radiologist.Setting: Teaching hospital chest radiology department.Patients: Twenty-one adult patients with a final diagnosis of malignant mesothelioma were identified from 53 consecutive patients who underwent percutaneous image-guided CNB. All 21 patients had pleural thickening identified on contrast-enhanced CT, and all had a final histologic diagnosis of mesothelioma confirmed by postmortem examination or thoracoscopy.Interventions: Fourteen-gauge and 18-gauge cutting needles were used. Biopsy guidance was by ultrasound in 6 patients and by CT in 15 patients.Measurements and Results: A correct histologic diagnosis of malignant mesothelioma was made by CNB in 18 patients (86% sensitivity and 100% specificity). Complications included one chest wall hematoma and a small hemoptysis. Four patients with a pleural thickness of < or = 5 mm underwent biopsy, and all specimens were diagnostic for mesothelioma.Conclusions: Image-guided percutaneous CNB of pleural thickening is a safe procedure, with 86% sensitivity for detecting malignant mesothelioma. Pleural thickening of < or = 5 mm may be successfully sampled. [ABSTRACT FROM AUTHOR]

The article reports on the first six consecutive 1-day theoretical and practical thoracic ultrasound (TUS) consecutive courses established by the British Thoracic Society pleural diseases group. The lectures in the program included pathologic conditions, ultrasound physics, governance, and machine care. It was found that participant performance improved at the end of the course. Poor availability of local mentors was cited as the primary reason for failure to attain TUS accreditation.

Study objectives: Parapneumonic effusions are common, and measurement of pleural pH is one of the most useful measurements in assessing the need for tube drainage. Use of pleural pH assumes that a single measurement conveys a representative picture of pH throughout the effusion. Often effusions are multiloculated, and varying concentrations of nondiffusible acids such as lactic acid, if present in different concentrations, could mean clinically significant variations in pH between locules. If these differences were large, a single pH measurement could misrepresent the "stage" that the parapneumonic effusion had reached. We therefore set out to test the hypothesis that pH varies significantly between locules in complicated parapneumonic effusions. Design: The study was performed in seven consecutive patients presenting to our institution with complicated parapneumonic effusions. Interventions: In each case, pleural pH was measured in several separate pleural fluid locules, using ultrasound-guided pleural fluid sampling. Results: Significant variations were found in pleural fluid visual appearance, pH, and lactate dehydrogenase between locules in four of seven patients. Three of seven patients had variations, resulting in pH levels both above and below 7.2, which is the threshold used in our institution to indicate the need for tube drainage. Conclusions: This is the first reported series of variation in pleural pH between different locules in complicated parapneumonic effusions. These variations are clinically important and cast light on the mechanisms responsible for the acidosis seen in infected effusions. Physicians should be aware of this when making drainage decisions in these patients using the clinical picture and a single pH result alone. [ABSTRACT FROM AUTHOR]

Local anesthetic (medical) thoracoscopy is used with increasing frequency by pulmonologists worldwide for both diagnostic and therapeutic purposes, notably in comorbid patients who may not be physiologically robust enough for general anesthesia. Understanding the complications that can arise and how to manage them is crucial for any physician performing this procedure. Reexpansion pulmonary edema is a rare but recognized complication of draining pleural effusions and pneumothoraces that has not been described previously in association with physician-led thoracoscopy. This case provides an opportunity for an overview of what is known about this unusual but potentially fatal condition. Data correlating ultrasonographic, radiographic, and clinical progression are also presented to highlight the potential usefulness of ultrasonography in identifying lung parenchymal abnormalities such as extravascular lung water. [ABSTRACT FROM AUTHOR]