Search

A pleural exudate that remains undiagnosed after a combined clinical assessment, thoracentesis, and imaging requires a pleural biopsy for a definitive diagnosis. Thoracoscopy is often the first method of choice to obtain tissue as it offers greater sensitivity and there is a perception of less risk. However, with imaging guidance, closed pleural biopsy is a safe, affordable, and effective alternative to diagnose all forms of pleural disease. Ultrasound (US) has several benefits when compared with computed tomography for image-guided biopsy, as it is widely available, can be performed bedside, and does not expose the patient to radiation. If performed in optimal conditions, a transthoracic USguided closed pleural biopsy can yield results comparable to those of thoracoscopy and a marked reduction in the complication rate versus blind biopsy. Abrams and Tru-Cut needles are the most widely used for a closed pleural biopsy. Either may be used with real-time image guidance or with a free-hand image-assisted technique to harvest up to 6 separate tissue samples. The needle choice will depend on the morphology of the lesion observed on imaging. The Tru-Cut is generally preferred for mass lesions of the pleura or pleura that is >20 mm in thickness, and the Abrams for pleural thickening of <20 mm or radiologically normal pleura. A transthoracic US may be used to detect, rule out, and prevent complications, such as bleeding, solid organ injury, or pneumothorax. The ability to perform thoracic US is a necessary skill in current respiratory practice, and US-guided closed pleural biopsy has a critical role in diagnosis. [ABSTRACT FROM AUTHOR]

A 30-year-old female with no significant past medical history was referred to our facility with sudden onset of shortness of breath. She had a low clinical probability for pulmonary thromboembolism and a computed tomography angiogram showed enlarged pulmonary arteries but no in situ thrombi. She developed recurrent episodes of hypotension and hypoxia, and was transferred to the intensive care unit where she died despite active resuscitation. An autopsy revealed extensive lymphatic and pulmonary vascular tumour emboli as the immediate cause of death. Pulmonary tumour embolism is a very rare cause of death, but can occur in patients who have an occult neoplasm. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflicts of Interest: RN van Zyl-Smit has received honoraria for academic talks and advisory boards from Astra Zeneca, GSK, ASPEN, Novartis, Cipla, MSD, Roche, Pfizer, Adcock Ingram. MS Abdool-Gaffar has received honoraria for talks from Novartis, Astra Zeneca, GSK/Aspen and Pfizer. C Smith has received honoraria for academic talks and advisory boards from Astra Zeneca, GSK/Aspen, Novartis, Cipla. CF Koegelenberg has received honoraria for academic talks and advisory boards from Astra Zeneca. K Dheda has received honoraria for academic symposia, membership of advisory boards, and/ or grant support from Astra Zeneca, GSK, Novartis, Adcock Ingram, Nycomed Takeda, Cipla, and MSD. B Allwood has received honoraria for academic talks from Novartis. A Goolam-Mahomed has received honoraria for Academic talks, advisory boards and congress attendance from Astra-Zeneca and GSK-Aspen. ML Wong has received honoraria for academic talks from AstraZeneca, Cipla, Novartis, Boehringer-Ingelheim, MSD. UG Lalloo has received honoraria for academic symposia, membership of advisory boards for Astra-Zeneca, Aspen GSK, CIPLA, Novartis, Adcock Ingram, Nycomed Takeda and MSD. G Calligaro has received honoraria for academic talks from Astra-Zeneca, Novartis.