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LETTER TO THE EDITOR
Year : 2017  |  Volume : 12  |  Issue : 3  |  Page : 216-217
Role of pleural transthoracic ultrasound guidance


1 Department of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
2 Department of Internal Medicine, Interventional Ultrasound Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy

Date of Web Publication13-Jul-2017

Correspondence Address:
Maria Giulia Tinti
Department of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG)
Italy
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DOI: 10.4103/atm.ATM_77_17

PMID: 28808496

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How to cite this article:
Tinti MG, Frongillo E, Sperandeo M. Role of pleural transthoracic ultrasound guidance. Ann Thorac Med 2017;12:216-7

How to cite this URL:
Tinti MG, Frongillo E, Sperandeo M. Role of pleural transthoracic ultrasound guidance. Ann Thorac Med [serial online] 2017 [cited 2019 Oct 19];12:216-7. Available from: http://www.thoracicmedicine.org/text.asp?2017/12/3/216/210610




Sir,

We read with interest the article by Ferreiro et al.,[1] recently published in your journal, focused on the correct management of pleural malignant effusions.

We absolutely agree that thoracentesis is one of the first approaches in pleural malignant effusions. However, procedure-related complications with transthoracic ultrasound (TUS) guidance are less frequent than reported in the review. We have performed 3870 drainages in the last 10 year with TUS guidance.[2] A diagnosis of malignant effusion was done in 630 patients (18%) with cytology on fluid samples. The rate of major complications was low: only four patients (0.1%) had iatrogenic pneumothorax (three showed partial pneumothorax and one subtotal pneumothorax; with full lung reexpansion in each case), and two patients had reexpansion lung edema.[2]

Under TUS guidance, it is also possible to determine the real-time characteristics of pleural effusion.[3] Indeed, accordingly to the US pattern of pleural effusion (anechoic, complex nonloculated, complex loculated, and homogeneously hyperechoic) [Figure 1], it is possible to choose the right needle size, i.e., generally an atraumatic 20-gauge and to use a low-flow and low-pressure aspiration system.[3] Moreover, it is advisable the use of dedicated probe, i.e., with a central hole through which the needle set is introduced.[4]
Figure 1: Transthoracic ultrasound pleural effusion patterns: (a) anechoic, (b) homogeneously hyperechoic, (c) complex nonloculated, (d) complex loculated

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One of the most relevant advantages of US guidance is the real-time needle visualization during the procedure.[4] In this way, the physician can retract the needle during lung reexpansion, avoiding pneumothorax, and hemothorax [Figure 2].
Figure 2: During transthoracic ultrasound-guided thoracentesis, the physician can check the needle position throughout the procedure (yellow arrow)

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TUS guidance is the primary procedure in the pleural fine needle aspiration biopsy (FNAB).[5] It allows us to perform a step-by-step FNAB with more ease and advantages in comparison with blind or computed tomography scan-guided biopsies.[5] Moreover, the FNAB-dedicated probes allow the physician to reach the lesion under the coaxial view, getting specimens of length, thickness, and quality adequate for pathology assessment.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ferreiro L, Suárez-Antelo J, Valdés L. Pleural procedures in the management of malignant effusions. Ann Thorac Med 2017;12:3-10.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sperandeo M, Catalano D, Melillo N, Foti T, Trovato GM. Transthoracic ultrasound for pleural effusion: Traps and tricks. Shortness Breath 2014;3:28-35.  Back to cited text no. 2
    
3.
Sperandeo M, Rotondo A, Guglielmi G, Catalano D, Feragalli B, Trovato GM. Transthoracic ultrasound in the assessment of pleural and pulmonary diseases: Use and limitations. Radiol Med 2014;119:729-40.  Back to cited text no. 3
[PUBMED]    
4.
Trovato GM, Sperandeo M, Catalano D. Thoracic ultrasound guidance for access to pleural, peritoneal, and pericardial space. Chest 2013;144:1735-6.  Back to cited text no. 4
[PUBMED]    
5.
Sperandeo M, Dimitri L, Pirri C, Trovato FM, Catalano D, Trovato GM. Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma. Chest 2014;146:e178-9.  Back to cited text no. 5
[PUBMED]    


    Figures

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