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To evaluate the possible prognostic significance of the development of peripheral consolidations at chest x-ray in COVID-19 pneumonia, we retrospectively studied 92 patients with severe respiratory failure (PaO

For a long time, Medical Thoracoscopy (MT) has played a marginal role in the management of pleural infection but in recent years his role has become more established. Pleural empyema defined as pus in the pleural cavity has been subdivided on the basis of ultrasonography and endoscopic appearance into 3 stages: free-flowing effusion (stage 1), multiloculated with a tendency toward loculations (stage 2) and chronic fibrous thickening involving also visceral pleural (stage 3). (Fig.1) Aim: The aim of this study was to evaluate efficacy and safety of medical thoracoscopy in patients with all stages of infectious pleural effusion Methods: We performed a retrospective study of patients referred for empyema and treated by medical thoracoscopy at Brescia and Sarzana pleural disease departments from December 2016 to December 2019. All patients underwent ultrasonography to localize and to stage pleural fluid collection and received MT with rigid thoracoscope to identify and break down fibrous pleural adhesions. Results: A total of 83 patients with empyema were treated by medical thoracoscopy; empyema was stage 1 in 6 patients ( 7,2%), stage 2 in 44 patients (53 %), and stage 3 in 33 patients ( 39,8%). MT was successful without further intervention in 79 patients (95,2%): all patients with stage 1 and 2 and 29 patients with stage 3 organizing effusion. Only 4 (12%) of the 33 patients with stage 3 required surgical intervention. Conclusion: pleural empyema, as stratified by ultrasonography, can safely and successfully be treated by MT in particular if performed in early stages of infection.

Background: TTP is one of the most effective pleurodesis methods in MPE but its optimal timing is not well-defined. While some groups perform thoracoscopic pleurodesis on the basis of endoscopic malignancy appearance during diagnostic medical thoracoscopy (MT), others wait for a definitive histological diagnosis. Aim: to evaluate if the presence of thoracoscopic features of neoplastic pleural involvement predicts the final diagnosis of malignancy and if TTP decreases PE recurrence in these cases. Methods: We included consecutive patients, among those referred for MT to two pleural units (1, Brescia and 2, Sarzana), with unilateral PE and an endoscopic appearance of malignant pleural involvement (nodules, masses, thickenings or mixed lesions). During MT all patients received pleural biopsies but only the patients referred to unit 1 received TTP. All cases with recurrent symptomatic PE that required drainage in the following 3 months were deemed as failures. Results: 62 patients (59 malignancies) were included (32/group). The positive predictive value of endoscopic appearance was 100% for nodules, masses and mixed lesions, 82.4% for thickenings. In group 1, the recurrence of PE was significantly lower than in group 2 (6.7% vs 56.7%, p Conclusion: The accuracy of endoscopic appearance of malignancy was high, particularly in the presence of nodules, masses and mixed lesions. In the presence of these lesions, TTP might be warranted prior to final histological diagnosis to reduce recurrence of PE and the ensuing necessity for reintervention. Caution is necessary when thickening is the only feature.

Soluble mesothelin-related peptide (SMRP) is regarded as an FDA approved biomarker for the diagnosis and monitoring of pleural malignant mesothelioma (MPM). We detected the SMRP levels in pleural effusions (PE) by means of an ELISA and analyzed their diagnostic relevance to differentiate MPM from benign pathology and from non-MPM pleural metastasis. Comparison with cytology in MPM-PE was also performed. We found that SMRP detection in MPM-PE can help the diagnosis of MPM and provide additional diagnostic value to cytology. We concluded that SMRP test may be incorporated into clinical practice of PE from patients suspicious for MPM.

Background human mammaglobin (hMAM) expression has been reported in pleural effusions (PE). The aim of this study was to assess the clinical relevance of hMAM mRNA in PE from patients who underwent thoracoscopy. Material and methods A total of 288 patients with PE were studied, 155 of which were diagnosed with malignant and 133 with non-malignant diseases by thoracoscopy. Cells from PE were analyzed by nested hMAM RT-PCR. Statistical analyses were performed to evaluate the diagnostic performance parameters (DPP), the association between hMAM expression and benign or malignant status and the relative risk of cancer for patients with negative thoracoscopy showing hMAM positivity. Results hMAM mRNA was found in 68/288 (23.6%) PE samples of which 51 were from the 155 patients diagnosed with malignant diseases and 17 were from the 133 patients diagnosed with non-malignant diseases. A significant correlation between hMAM expression and malignancy was found (OR=3.04) and the DPP were as follows: sensitivity=32.9%, specificity=87.2%, accuracy=58.0%, positive predictive value=75.0% and negative predictive value=52.7%. Among the patients with negative thoracoscopy (n=133), 5/17 (29.4%) hMAM-positive patients had or developed a tumor during the 18-month follow up period, as compared to 10/116 (8.6%) hMAM-negative patients (relative risk of 4.6 for developing a malignancy). Conclusion These findings suggest a possible application of hMAM RT-PCR detection in PE as to identify a false-negative thoracoscopy in non-specific pleuritis.

We report a case of acute fibrinous and organising pneumonia in Whipple’s disease with lung improvement after antibiotic therapy. In our knowledge this is the first report of Whipple’s disease with acute fibrinous and organising pneumonia.

The aim of this study based on the third phase of the architecture of diagnostic research was to assess the sensitivity and specificity of soluble mesothelin-related peptide (SMRP) in pleural exudative effusions (PE) compared to the histology obtained by medical thoracoscopy as the diagnostic gold standard examination. We assessed 104 consecutive thoracoscopies. SMRP concentrations were obtained using an ELISA test. We had 34 mesotheliomas (25 epithelioid and 9 sarcomatoid), 35 pleural metastases, and 35 benign diseases. PE-SMRP were significantly higher in patients with epitheliomorphic mesothelioma (mean ± SD 46.55 ± 44.29 nM) than in patients with sarcomatoid mesothelioma (16.11 ± 25.02 nM; p = 0.061), pleural metastasis (7.52 ± 10.77 nM; p < 0.0001), or benign diseases (5.82 ± 8.86 nM; p < 0.0001). Using ROC curve analysis, PE-SMRP offered an AUC of 0.767 in its ability to differentiate between patients with mesothelioma and all other diagnoses. The diagnostic sensitivity and specificity of PE-SMRP for distinguishing mesothelioma from all other causes of pleural effusion, at a cut-off value of 19.6 nM, were 58.8 and 97.1 %, respectively. PE-SMRP higher than the assumed cut-off of 19.6 nM were observed in 18/25 (72.0%) epitheliomorphic mesotheliomas, 2/9 (22.2%) sarcomatoid mesotheliomas, 5/35 (14.3%) pleural metastases, and 1/35 (2.9%) benign diseases. We conclude that PE-SMRP adds some clinical information in the work-up of patients with a PE of unknown origin: (1) thoracoscopy should always be done in patients with a positive mesothelin; (2) a negative mesothelin does not exclude a malignant disease.

As was reported that human mammaglobin (hMAM) may be expressed in malignant pleural effusions (PEs), we investigated the relevance of hMAM reverse-transcriptase polymerase chain reaction (RT-PCR) for their diagnosis and determination of primary origin. Two hundred and twenty-eight malignant (132 male, 96 female) and 185 benign (132 male, 53 female) PEs were investigated. Statistical analyses evaluated the diagnostic performance parameters in all PEs and in cytologically negative malignant PEs, the association between hMAM and benign or malignant status by the direct index of correlation [diagnostic odds ratio (DOR)], chi test, and P value (P). In addition, the discriminative diagnostic power of hMAM expression, independently in breast cancer, lung cancer (LC), malignant mesothelioma (MM), and other cancers was evaluated. In the entire patient population, hMAM was detected in 45.6% and 5.4% of malignant and benign PEs, respectively, in the male group in 41.7% and 4.5% and in the female group in 51.0% and 7.5% of malignant and benign PEs, respectively. A statistically significant correlation between hMAM and malignancy was found in the entire population (DOR=14.68, P