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Patients with secondary spontaneous pneumothorax (SSP) complicated by persistent air leak (PAL) and who are poor surgical candidates have limited treatment options. This case series explored autologous blood patch pleurodesis as a possible cost-effective management option. A total of 46 episodes of SSP with PAL were included. The procedure was successful in 33 (71.7%). Of these, 17 (51.5%) resolved within 1 day. The mean duration of intercostal drainage prior to the blood patch was 22 days in the successful group. Pneumothoraces with incomplete lung re-expansion at the time of procedure were successful in 20 of 30 (66.7%). Only human immunodeficiency virus infection was associated with failure (p = 0.03). Adverse events included transient fever (n = 3) that resolved spontaneously, and empyema (n = 3) which were successfully managed with antibiotics and pigtail drainage. We conclude that a large proportion of patients with SSP complicated by PAL who are unfit for surgery may be liberated from intercostal drainage by an autologous blood patch pleurodesis, with minimal adverse effects. [ABSTRACT FROM AUTHOR]

In high-burden settings, the diagnosis of pleural tuberculosis (TB) is frequently inferred in patients who present with lymphocyte predominant exudative effusions and high adenosine deaminase (ADA) levels. Two recent small retrospective studies suggested that the lactate dehydrogenase (LDH)/ADA ratio is significantly lower in TB than in non-TB pleural effusions and that the LDH/ADA ratio may be useful in differentiating pleural TB from other pleural exudates. We compared the pleural LDH/ADA ratios, ADA levels, and lymphocyte predominance of a prospectively collected cohort of patients with proven pleural TB (n = 160) to those with a definitive alternative diagnosis (n = 68). The mean pleural fluid LDH/ADA ratio was lower in patients with pleural TB than alternative diagnoses (6.2 vs. 34.3, p < 0.001). The area under the receiver operating characteristic curve was 0.92 (p < 0.001) for LDH/ADA ratio and 0.88 (p < 0.001) for an ADA ≥40 U/L alone. A ratio of ≤12.5 had the best overall diagnostic efficiency, while a ratio of ≤10 had a specificity of 90% and a positive predictive value of 95%, with a sensitivity of 78%, making it a clinically useful "rule in" value for pleural TB in high incidence settings. When comparing the LDH/ADA ratio to an ADA level ≥40 U/L in the presence of a lymphocyte predominant effusion, the latter performed better. When lymphocyte values are unavailable, our data suggest that the LDH/ADA ratio is valuable in distinguishing TB effusions from other pleural exudates. [ABSTRACT FROM AUTHOR]

The article focuses on remarkable aspect of the COVID-19 pandemic is the intensity of the search for novel diagnostic and therapeutic tools. Topics include the recognition that COVID-19 is a novel disease with a multitude of clinical manifestations and unexpected respiratory phenotypes, overwhelming number of severely ill patients with COVID-19 pneumonia has generated a lot of information, and the data has poured out of country after country has passed many problems of COVID-19.

The authors convey their thoughts about indwelling pleural catheters (IPCs) for malignant pleural effusions. Topics mentioned include the practice of offering pleural interventions to patients who are truly asymptomatic, the impact of IPCs on the need for further pleural interventions and the number of days spent in hospital, and the use of a low-cost alternative to the current commercially available IPCs.

The article offers information no a study related to the effects of transthoracic ultrasound (TUS) of ultrasonography on daily clinical practitioners. Topics discussed include use of TUS for the assessment of pleural effusions (PE), pneumothoraces, pneumonia, and lung cancer; the role of aetiology and chronicity of an effusion in variations in the TUS appearance of a PE; and the results showing that the echogenicity of a PE have low specificity for identifying an underlying exudate.

The article talks about identification of pleural fluid loculations through the lateral decubitus radiograph. Topics discussed include information collected from 86 patients who had a medical thoracoscopy with documentation of presence or absence of pleural adhesions; need to introduce a familiarity with the ultrasound machine and its interpretation in basic medical training, and comparison between Ultrasound-guided pulmonary biopsy and CT-guided biopsy.

The article discusses research being done on the management of malignant pleural effusion (MPE). It references the study "Pleurodesis Using Mistletoe Extracts Delivered via a Spray Catheter During Semi-Rigid Pleuroscopy for Managing Symptomatic Malignant Pleural Effusion," by J. S. Eom in this issue. Topics covered include the shortage of high-quality evidence on the therapeutic approach to MPE, the use of talc as chemical pleurodesis, and the anticancer effects of mistletoe extract.

The article discusses the evolution of endoscopic pleuroscopy, and mentions risk of postoperative infection during surgical or open thoracotomy in forms of an empyema, pneumonia or a surgical site infection. It states recommendations of antimicrobial prophylaxis in after thoracic procedures in patients with risk factors such as asplenia, prosthetic heart valves and endocarditis.