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Huan NC, Kho SS, Nyanti LE, Ramarmuty HY, Rahim MAA, Ho RL, Lo SM, Tie ST, Kannan KKS. Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle. Tuberc Respir Dis (Seoul) 2025; 88:181-189. [PMID: 39542010 PMCID: PMC11704731 DOI: 10.4046/trd.2024.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/27/2024] [Accepted: 11/11/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times. METHODS We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement. RESULTS Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported. CONCLUSION These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.
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Affiliation(s)
- Nai-Chien Huan
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Sze Shyang Kho
- Division of Respiratory Medicine, Department of Medicine, Sarawak General Hospital, Kuching, Malaysia
| | - Larry Ellee Nyanti
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
- Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Hema Yamini Ramarmuty
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Muhammad Aklil Abd Rahim
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Rong Lih Ho
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Shan Min Lo
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Siew Teck Tie
- Division of Respiratory Medicine, Department of Medicine, Sarawak General Hospital, Kuching, Malaysia
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Huang Y, Wang X, Li J, He Q, Wang R. Knowledge, attitude, and practice towards enhanced recovery after surgery among patients underwent thoracoscopy surgery. PLoS One 2024; 19:e0309821. [PMID: 39231166 PMCID: PMC11373802 DOI: 10.1371/journal.pone.0309821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 08/19/2024] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVE Thoracoscopy has gained extensive utilization in managing pleural disorders, and enhanced recovery after surgery (ERAS) can improve patients' prognosis and expedite post-surgical recovery. This study aimed to investigate the knowledge, attitudes, and practices (KAP) towards ERAS among patients underwent thoracoscopy surgery. METHODS This cross-sectional study was conducted between September 2022 and August 2023, among patients underwent thoracoscopy surgery in 6 Secondary or Tertiary hospitals in the author's area. Demographic characteristics and KAP scores were collected by questionnaires, and clinical data were extracted from medical records. RESULTS A total of 309 valid questionnaires were collected, with 165 (53.40%) males and 202 (65.37%) aged ≤65 years old. The mean scores for KAP were 28.92±7.21 (possible range: 9-45), 53.60±6.73 (possible range: 13-65), and 43.45±5.50 (possible range: 10-50), respectively. SEM confirmed the positive associations between knowledge and attitude (β = 0.108, P = 0.019), knowledge and practice (β = 0.096, P = 0.004), and attitude and practice (β = 0.438, P<0.001). However, the KAP were found not associated with prognosis. CONCLUSION Patients underwent thoracoscopy surgery showed moderate knowledge, positive attitude, and appropriate practice towards ERAS. Preoperative education, personalized counseling, peer support groups, peer support groups, and follow-up care were recommended in further clinical practice.
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Affiliation(s)
- Yinping Huang
- Lu' an People' s Hospital General thoracic surgery, Lu' an, China
| | - Xingbang Wang
- Lu' an People' s Hospital General thoracic surgery, Lu' an, China
| | - Jiajia Li
- Lu' an People' s Hospital General thoracic surgery, Lu' an, China
| | - Qing He
- Lu' an People' s Hospital General thoracic surgery, Lu' an, China
| | - Rui Wang
- Lu' an People' s Hospital General thoracic surgery, Lu' an, China
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Fantin A, Castaldo N, Crisafulli E, Sartori G, Aujayeb A, Vailati P, Morana G, Patrucco F, de Martino M, Isola M, Patruno V. The Role of Medical Thoracoscopy with Talc Poudrage in Spontaneous, Iatrogenic, and Traumatic Pneumothorax: A Prolonged Experience of a Tertiary Care Center. Pulm Ther 2024; 10:347-362. [PMID: 39126456 PMCID: PMC11339209 DOI: 10.1007/s41030-024-00268-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Medical thoracoscopy is a minimally invasive and safe procedure mostly performed for unexplained exudative pleural effusions but may be considered for pneumothorax (PNX). METHODS This retrospective study included participants affected by PNX who underwent medical thoracoscopy with talc poudrage at a single academic hospital from 2008 to 2021. The primary endpoint was the observation of complete radiographical lung re-expansion and absence of air supply from the chest drain within 7 days of medical thoracoscopy. The secondary endpoint was achieving no recurrence of ipsilateral PNX at 24 months post-discharge. RESULTS A total of 95 patients affected by primary spontaneous PNX (PSP), secondary spontaneous PNX (SSP), iatrogenic, and traumatic PNX were enrolled. An additional procedure was required by 17.89% of patients, and only one patient with SSP required subsequent surgery. Recurrence of PNX occurred on the same side within 24 months after discharge in 9.47% of patients, with a median time to recurrence of 13.5 months. The PSP group was significantly more likely to achieve the primary endpoint. Pleural morphology was significantly associated with reaching the primary endpoint, while receiving a cumulative dose of talc greater than or equal to 4 g during hospitalization was associated with a lower risk of meeting it. Receiving a cumulative dose of talc greater than or equal to 4 g led in all cases to the achievement of the secondary endpoint. Patients with iatrogenic and traumatic PNX had an excellent prognosis in both the short- and long-term evaluation. CONCLUSION Medical thoracoscopy is an effective procedure for treating PNX in the acute setting in selected cases while preventing long-term relapses. Large prospective clinical studies are needed to support and better define the role of medical thoracoscopy in current clinical practice.
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Affiliation(s)
- Alberto Fantin
- Department of Pulmonology, Santa Maria della Misericordia University Hospital, Via Colugna, 33100, Udine, Italy.
| | - Nadia Castaldo
- Department of Pulmonology, Santa Maria della Misericordia University Hospital, Via Colugna, 33100, Udine, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giulia Sartori
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Paolo Vailati
- Department of Pulmonology, Santa Maria della Misericordia University Hospital, Via Colugna, 33100, Udine, Italy
| | - Giuseppe Morana
- Department of Pulmonology, Santa Maria della Misericordia University Hospital, Via Colugna, 33100, Udine, Italy
| | - Filippo Patrucco
- Division of Respiratory Diseases, Department of Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Maria de Martino
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Miriam Isola
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Vincenzo Patruno
- Department of Pulmonology, Santa Maria della Misericordia University Hospital, Via Colugna, 33100, Udine, Italy
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Piazzolla M, De Pace CC, Porcel JM, Tondo P. Local Anesthetic Thoracoscopy: A Focus on Indications, Techniques and Complications. Arch Bronconeumol 2024; 60:423-430. [PMID: 38744546 DOI: 10.1016/j.arbres.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
The main purpose of this narrative review is to educate general practitioners about a crucial pleural procedure, namely local anesthetic thoracoscopy (LAT), and to provide established respiratory physicians with an expert opinion-based summary of the literature. This narrative review focuses on the indications, technical aspects and complications of LAT, highlighting its safety and high degree of diagnostic sensitivity for patients who present with an unexplained pleural effusion and have a high pre-test probability of cancer.
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Affiliation(s)
- Michele Piazzolla
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Thoracic Surgery Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Cosimo C De Pace
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Institute of Respiratory Diseases, University Hospital Policlinico of Foggia, Foggia, Italy.
| | - José M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Institute of Respiratory Diseases, University Hospital Policlinico of Foggia, Foggia, Italy
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Chawla RK, Kumar M, Madan A, Dhar R, Gupta R, Gothi D, Desai U, Goel M, Swarankar R, Nene A, Munje R, Chaudhary D, Guleria R, Hadda V, Nangia V, Sindhwani G, Chawla R, Dutt N, Yuvarajan, Dalal S, Gaur SN, Katiyar S, Samaria JK, Gupta KB, Koul PA, Suryakant, Christopher D, Roy D, Hazarika B, Luhadia SK, Jaiswal A, Madan K, Gupta PP, Prashad B, Yusuf N, James P, Dhamija A, Tomar V, Parakh U, Khan A, Garg R, Singh S, Joshi V, Sarangdhar N, Chaudhary SR, Nayar S, Patel A, Gupta M, Dixit RK, Jain S, Gogia P, Agarwal M, Katiyar S, Chawla A, Gonuguntala HK, Dosi R, Chinnamchetty V, Jindal A, Sharma S, Chachra V, Samaria U, Nair A, Mohan S, Maitra G, Sinha A, Kochar R, Yadav A, Choudhary G, Arunachalam M, Rangarajan A, Sanjan G. NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy. Lung India 2024; 41:151-167. [PMID: 38700413 PMCID: PMC10959315 DOI: 10.4103/lungindia.lungindia_5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 05/05/2024] Open
Abstract
Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.
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Affiliation(s)
- Rakesh K. Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital and Saroj Super Speciality Hospital, New Delhi, India
| | - Mahendra Kumar
- Department of Respiratory Medicine, Institute of Respiratory Diseases, SMS Medical College Jaipur, Rajasthan, India
| | - Arun Madan
- Department of Respiratory Medicine, NDMC Medical College, Delhi, India
| | - Raja Dhar
- Department of Pulmonology, C K Birla Group of Hospitals, Kolkata, West Bengal, India
| | - Richa Gupta
- Department of Respiratory Medicine, CMC Hospital, Vellore, Tamil Nadu, India
| | - Dipti Gothi
- Department of Respiratory Medicine, ESI- PGIMSR, Delhi, India
| | - Unnati Desai
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Manoj Goel
- Department of Pulmonary, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Rajesh Swarankar
- Respiratory, Critical Care and Sleep Medicine, Get Well Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Amita Nene
- Department of Respiratory Medicine, Bombay Hospital, Mumbai, Maharashtra, India
| | - Radha Munje
- Department of Respiratory Medicine, IGGMCH Nagpur, Maharashtra, India
| | - Dhruv Chaudhary
- Department of Pulmonary Medicine, PGIMS Rohtak, Haryana, India
| | - Randeep Guleria
- Chairman, Institute of Internal Medicine, Respiratory and Sleep Medicine Medanta, Gurugram, Haryana, India
- Director, Medical Education Respiratory and Sleep Medicine Medanta, Gurugram, Haryana, India
| | - Vijay Hadda
- Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Nangia
- Pulmonary, Critical Care, and Sleep Medicine, MAX Super Speciality Hospital Saket, New Delhi, India
| | | | - Rajesh Chawla
- Respiratory Medicine, Indraprastha Apollo Hospitals, Delhi, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, AIIMS Jodhpur, Rajasthan, India
| | - Yuvarajan
- Department of Respiratory Medicine, SMVMCH, Pondicherry, India
| | - Sonia Dalal
- Pulmonologist and Director, Dalal Sleep and Chest Medical Institute Pvt Ltd Vadodara, Gujarat, India
| | - Shailendra Nath Gaur
- Department of Respiratory Medicine, Sharda Medical College, Noida, Uttar Pradesh, India
| | - Subodh Katiyar
- Department of Tuberculosis and Respiratory Diseases, G. S. V. M. Medical College, Kanpur, Uttar Pradseh, India
| | - Jai Kumar Samaria
- Department of Chest Diseases, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Director and Chief Consultant, Centre for Research and Treatment of Allergy, Asthma and Bronchitis and Dr. Samaria Multispeciality Centre Varanasi, Uttar Pradesh, India
| | - K. B Gupta
- Department of Pulmonary Medicine PGIMS Rohtak, Haryana, India
| | - Parvaiz A Koul
- Pulmonary Medicine and Director, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Suryakant
- Department of Respiratory Medicine, King George’s Medical University UP Lucknow, Uttar Pradesh, India
| | - D.J. Christopher
- Department of Pulmonary Medicine, CMC, Vellore, Tamil Nadu, India
| | - Dhrubajyoti Roy
- Pulmonary and Respiratory Medicine in Columbia Asia Hospital, Salt Lake Kolkata, West Bengal, India
| | - Basant Hazarika
- Department of Pulmonary Medicine Guwahati Medical College, Guwahati, Assam, India
| | - Shanti Kumar Luhadia
- Department of Respiratory Medicine, Geetanjali Medical College and Hospital Udaipur, Rajasthan, India
| | - Anand Jaiswal
- Director, Respiratory and Sleep Medicine Medanta, The Medicity Gurugram, Haryana, India
| | - Karan Madan
- Pulmonary Medicine and Sleep Disorders Department, AIIMS, Delhi, India
| | | | - B.N.B.M. Prashad
- Department of Respiratory Medicine, KGMC, Lucknow, Uttar Pradesh, India
| | - Nasser Yusuf
- Department of Minimally Invasive Thoracic Surgery, Sunrise Group of Hospitals Kochi, Calicut, Kerala, India
| | - Prince James
- Interventional Pulmonology and Respiratory Medicine Naruvi Hospitals, Vellore, Tamil Nadu, India
| | - Amit Dhamija
- Chest Medicine, Sir Ganga Ram Hospital New Delhi, India
| | - Veerotam Tomar
- Director and Consultant Pulmonologist, Dr Shivraj Memorial Chest and Maternity Centre Meerut, Uttar Pradesh, India
| | - Ujjwal Parakh
- Department of Respiratory Medicine, Sir Ganga Ram Hospital New Delhi, India
| | - Ajmal Khan
- Department of Pulmonary and Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, Uttar Pradesh, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine AIIMS, New Delhi, India
| | - Sheetu Singh
- Director, Asthma Bhawan, Rajasthan Hospital, Rajasthan, India
| | - Vinod Joshi
- Principal and Controller, RUHS College of Medical Sciences, Jaipur, Rajasthan, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
| | | | - Sandeep Nayar
- Senior Director and Head Centre for Chest and Respiratory Diseases BLK-Max Super Speciality Hospital, New Delhi, India
| | - Anand Patel
- Department of Pulmonary Medicine GMERS Medical College and Hospital, Gujarat, India
| | - Mansi Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, SGPGI Lucknow, Uttar Pradesh, India
| | - Rama Kant Dixit
- Department of Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan, India
| | - Sushil Jain
- Department of Respiratory Medicine, APOLLO, Raipur, Chhattisgarh, India
| | - Pratibha Gogia
- Respiratory Medicine, Allergy and Sleep Disorders Department, Venkateshwar Hospital, Dwarka, New Delhi, India
| | - Manish Agarwal
- Pulmonary Medicine and Sleep Disorders Department, Jaipur Golden Hospital, Delhi, India
| | | | - Aditya Chawla
- Department of Respiratory Medicine, Sleep and Critical Care, Saroj Super Speciality Hospital and Jaipur Golden Hospital, New Delhi, India
| | | | - Ravi Dosi
- Consultant Chest Physician, Kokilaben Dhirubhai Ambani Hospital, Indore, Madhya Pradesh, India
| | - Vijya Chinnamchetty
- Lead Interventional Pulmonologist Apollo Health City, Hyderabad, Telangana, India
| | - Apar Jindal
- Lung Transplant Interventional Pulmonology and Respiratory Medicine MGM Healthcare, Chennai, Tamil Nadu, India
| | - Shubham Sharma
- Consultant Advanced Lung Failure and Transplant Pulmonologist, Yashoda Hospitals, Ghaziabad, UP, India
| | | | - Utsav Samaria
- Pulmonologist, Apollo Spectra Kanpur, Uttar Pradesh, India
| | - Avinash Nair
- Department of Respiratory Medicine Christian Medical College, Vellore, Tamil Nadu, India
| | - Shruti Mohan
- Department of Respiratory Medicine, Jaipur Golden Hospital New Delhi, India
| | - Gargi Maitra
- Pulmonologist, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Ashish Sinha
- Department of Respiratory Medicine, Jaipur Golden Hospital New Delhi, India
| | - Rishabh Kochar
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS Jodhpur, Rajasthan, India
| | - Ajit Yadav
- Department Respiratory Medicine MMIMSR, Ambala, Haryana, India
| | - Gaurav Choudhary
- Department of Respiratory Medicine, Jaipur Golden Hospital New Delhi, India
| | - M Arunachalam
- Pulmonary and Sleep Medicine Yatharth Wellness Super Speciality Hospital, Noida, Uttar Pradesh, India
| | | | - Ganesh Sanjan
- SR Pulmonary Medicine AIIMS, Rishikesh, Uttarakhand, India
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Ledwani A, Ghewade B, Jadhav U, Adwani S, Wagh P, Karnan A. Unveiling Insights: A Comprehensive Review of the Role of Medical Thoracoscopy in Pleural Effusion Assessment. Cureus 2024; 16:e53516. [PMID: 38440030 PMCID: PMC10911809 DOI: 10.7759/cureus.53516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Pleural effusion, characterized by abnormal fluid accumulation in the pleural cavity, poses diagnostic and therapeutic challenges across various medical conditions. This comprehensive review explores the role of medical thoracoscopy in assessing pleural effusions, providing insights into its historical context, procedural intricacies, diagnostic performance, safety considerations, and clinical applications. Medical thoracoscopy, a minimally invasive endoscopic procedure, offers advantages such as high diagnostic yield, therapeutic interventions, real-time assessment, and a minimally invasive nature. The review critically analyzes the procedure's advantages and disadvantages, including technical expertise, risk of complications, resource intensity, and patient selection criteria. Comparative analyses with alternative diagnostic modalities highlight the unique benefits of medical thoracoscopy in specific clinical scenarios. The diagnostic yield of medical thoracoscopy is examined, considering sensitivity and specificity in various contexts. Patient selection criteria, complications, and safety measures are discussed, emphasizing the importance of careful consideration in integrating thoracoscopy into clinical practice. The review further explores its clinical applications, including differentiating exudative and transudative effusions, identifying specific etiologies, and its role in treatment planning. In conclusion, medical thoracoscopy emerges as a valuable tool in the comprehensive management of pleural effusions, offering a nuanced approach to diagnosis and treatment. The evolving landscape of diagnostic modalities underscores the continued significance of medical thoracoscopy and potential advancements in the field.
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Affiliation(s)
- Anjana Ledwani
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sameer Adwani
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Pankaj Wagh
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Ashwin Karnan
- Respiratory Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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7
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Singh PK, Sharma A, Hooda S, Ahuja A. Novel technique for pain alleviation during diagnostic medical thoracoscopy. Indian J Tuberc 2024; 71:105-107. [PMID: 38296382 DOI: 10.1016/j.ijtb.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Pawan Kumar Singh
- Department of Pulmonary & Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, India.
| | - Ashok Sharma
- Department of Pulmonary & Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, India
| | - Suman Hooda
- Department of Pulmonary & Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, India
| | - Aman Ahuja
- Department of Pulmonary & Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, India
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8
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Ugajin M, Yanoma S, Kani H. Intrapleural Urokinase Injection after Medical Thoracoscopy for Empyema and Complicated Para-Pneumonic Effusion: A Case Series. Intern Med 2023; 62:571-576. [PMID: 35793957 PMCID: PMC10017240 DOI: 10.2169/internalmedicine.0060-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Empyema and complicated para-pneumonic effusion (CPPE) often require surgical intervention because of insufficient antibiotic effect and chest tube drainage. From January 2017 to September 2021, we encountered seven patients who underwent intrapleural urokinase injection after medical thoracoscopy for the treatment of empyema or CPPE. None of the seven patients required further surgical interventions or showed any complications associated with the therapeutic procedures. The combined use of intrapleural urokinase injections and medical thoracoscopy may be an effective and safe therapeutic option for the management of empyema and CPPE.
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Affiliation(s)
- Motoi Ugajin
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Japan
| | - Saki Yanoma
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, Japan
| | - Hisanori Kani
- Department of Thoracic Surgery, Nagoya Tokushukai General Hospital, Japan
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9
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Agmy G, Adam MF, El Sagheir SA, Mahmoud MA. Transthoracic sonographic scores in evaluating the success of different scelerosing modalities in patients with malignant pleural effusion. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Malignant pleural effusions (MPE) mostly arises from metastases to the pleura from other sites. Management of malignant effusions aims to palliate dyspnea and prevent the reaccumulation of pleural fluid to improve patients’ quality of life. Pleurodesis is the most common palliative treatment for patients with refractory MPE. This study was carried out to evaluate the performance of transthoracic sonographic (TUS) scores (pleural sliding and pleural adherence score) in predicting the success of pleurodesis by different modalities in patients with malignant pleural effusion. One hundred malignant pleural effusion patients were enrolled to an interventional clinical trial from September 2019 to April 2021 for palliative management of dyspnea. Pleurodesis for palliative treatment of dyspnea was done either spontaneously by the intercostal chest tube or by a sclerosing agent such as tetracycline solution or tetracycline poudrage or iodopovidine. Patients were randomly allocated to one of these four groups where each group included 25 patients. Transthoracic ultrasound was performed at baseline, and 1 month after pleurodesis and the lung sliding score and pleural adherence score were evaluated.
Results
Majority of patients (78%) had high baseline lung sliding score (7-8). Post pleurodesis only 11.4% had high scores (p<0.001), also the mean lung sliding score decreased significantly in comparison to the baseline values (p˂ 0.001) in the spontaneous, tetracycline solution, tetracycline poudrage, and iodopovidine groups (7.04 ± 1.02 vs. 4.85 ± 1.60, 7.28± 0.98 vs. 4.48± 1.75, 7.20±0.96 vs. 4.44 ± 1.45, 7.04±0.93 vs. 3.35±1.81, respectively). Iodopovidine pleurodesis group in comparison to the other modalities showed the highest pleural adherence score (12.64 ± 2.98) and absent lung sliding in 72.7% of cases and 70 % success rate. Pleural adherence score at cut off ≥ 12 showed 92.75% sensitivity, 89.47% specificity, 92.1 accuracy, and 0.911 area under the curve (AUC) for predicting successful pleurodesis.
Conclusion
TUS scores is a feasible, bedside, and accurate method to detect the outcome of pleurodesis. Iodopovidone was more effective than tetracycline solution, tetracycline poudrage, and spontaneous pleurodesis.
Trial registration
ClinicalTrials.gov. NCT04074902. Registered on 29 August 2019
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Cui F, Liu J, Du M, Fan J, Fu J, Geng Q, He M, Hu J, Li B, Li S, Li X, Liao YD, Lin L, Liu F, Liu J, Lv J, Pu Q, Tan L, Tian H, Wang M, Wang T, Wei L, Xu C, Xu S, Xu S, Yang H, Yu BT, Yu G, Yu Z, Lee CY, Pompeo E, Azari F, Igai H, Kim HK, Andolfi M, Hamaji M, Bassi M, Karenovics W, Yutaka Y, Shimada Y, Sakao Y, Sihoe ADL, Zhang Y, Zhang Z, Zhao J, Zhong W, Zhu Y, He J. Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022). Transl Lung Cancer Res 2022; 11:2318-2331. [PMID: 36519017 PMCID: PMC9742622 DOI: 10.21037/tlcr-22-810] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/21/2022] [Indexed: 08/27/2023]
Abstract
The use of the white-light thoracoscopy is hampered by the low contrast between oncologic margins and surrounding normal parenchyma. As a result, many patients with in situ or micro-infiltrating adenocarcinoma have to undergo lobectomy due to a lack of tactile and visual feedback in the resection of solitary pulmonary nodules. Near-infrared (NIR) guided indocyanine green (ICG) fluorescence imaging technique has been widely investigated due to its unique capability in addressing the current challenges; however, there is no special consensus on the evidence and recommendations for its preoperative and intraoperative applications. This manuscript will describe the development process of a consensus on ICG fluorescence-guided thoracoscopic resection of pulmonary lesions and make recommendations that can be applied in a greater number of centers. Specifically, an expert panel of thoracic surgeons and radiographers was formed. Based on the quality of evidence and strength of recommendations, the consensus was developed in conjunction with the Chinese Guidelines on Video-assisted Thoracoscopy, and the National Comprehensive Cancer Network (NCCN) guidelines on the management of pulmonary lesions. Each of the statements was discussed and agreed upon with a unanimous consensus amongst the panel. A total of 6 consensus statements were developed. Fluorescence-guided thoracoscopy has unique advantages in the visualization of pulmonary nodules, and recognition and resection of the anterior plane of the pulmonary segment. The expert panel agrees that fluorescence-guided thoracoscopic surgery has the potential to become a routine operation for the treatment of pulmonary lesions.
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Affiliation(s)
- Fei Cui
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ming Du
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junke Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming He
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xukai Li
- Department of Thoracic Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yong-De Liao
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Lin
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Liu
- Department of Thoracic Surgery, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jian Liu
- Anqing Hospital Affiliated to Anhui Medical University (Anqing Municipal Hospital), Anqing, China
| | - Junhong Lv
- Department of Thoracic Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Li Wei
- Department of Thoracic Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Chuan Xu
- Department of Thoracic Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Shidong Xu
- Department of Thoracic Surgery and Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Haoxian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ben-Tong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guangmao Yu
- Department of Cardiothoracic Surgery, Shaoxing People’s Hospital, Shaoxing Hospital, Zhejiang University, Shaoxing, China
| | - Zhentao Yu
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Feredun Azari
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Marco Andolfi
- Department of Thoracic Surgery, AOU Ospedali Riuniti of Ancona, Ancona, Italy
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | | | - Wolfram Karenovics
- Division of Thoracic and Endocrine Surgery, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Yi Zhang
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenfa Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Liu XT, Dong XL, Zhang Y, Fang P, Shi HY, Ming ZJ. Diagnostic value and safety of medical thoracoscopy for pleural effusion of different causes. World J Clin Cases 2022; 10:3088-3100. [PMID: 35647131 PMCID: PMC9082710 DOI: 10.12998/wjcc.v10.i10.3088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pleural effusions occur for various reasons, and their diagnosis remains challenging despite the availability of different diagnostic modalities. Medical thoracoscopy (MT) can be used for both diagnostic and therapeutic purposes, especially in patients with undiagnosed pleural effusion.
AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.
METHODS Between January 1, 2012 and April 30, 2021, patients with pleural effusion underwent MT in the Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University (Shaanxi, China). According to the discharge diagnosis, patients were divided into malignant pleural effusion (MPE), tuberculous pleural effusion (TBPE), and inflammatory pleural effusion (IPE) groups. General information, and tuberculosis- and effusion-related indices of the three groups were analyzed. The diagnostic yield, diagnostic accuracy, performance under thoracoscopy, and complications of patients were compared among the three groups. Then, the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.
RESULTS Of the 106 patients enrolled in this 10-year study, 67 were male and 39 female, with mean age of 57.1 ± 14.184 years. Among the 74 thoracoscopy-confirmed patients, 41 (38.7%) had MPE, 21 had (19.8%) TBPE, and 32 (30.2%) were undiagnosed. Overall diagnostic yield of MT was 69.8% (MPE: 75.9%, TBPE: 48.8%, and IPE: 75.0%, with diagnostic accuracies of 100%, 87.5%, and 75.0%, respectively). Under thoracoscopy, single or multiple pleural nodules were observed in 81.1% and pleural adhesions in 34.0% with pleural effusions. The most common complication was chest pain (41.5%), followed by chest tightness (11.3%) and fever (10.4%). Multivariate logistic regression analyses showed effusion appearance [odds ratio (OR): 0.001, 95%CI: 0.000-0.204; P = 0.010] and carcinoembryonic antigen (OR: 0.243, 95%CI: 0.081-0.728; P = 0.011) as significant for differentiating MPE and TBPE, with area under the receiver operating characteristic curve of 0.977 (95%CI: 0.953-1.000; P < 0.001).
CONCLUSION MT is an effective, safe, and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.
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Affiliation(s)
- Xiao-Ting Liu
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Xi-Lin Dong
- Department of Respiratory, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Yu Zhang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Ping Fang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Hong-Yang Shi
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Zong-Juan Ming
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
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Li S, Zhang QL, Guo RJ, Lv XZ, Yang X. Quantitative evaluation and significance of ultrasound in bronchoalveolar lavage for lung consolidation in children with severe mycoplasma pneumonia. Transl Pediatr 2021; 10:2325-2334. [PMID: 34733673 PMCID: PMC8506056 DOI: 10.21037/tp-21-381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effect of lung ultrasound on bronchoalveolar lavage in the treatment of mycoplasma pneumonia in children. METHODS Thirty children with mycoplasma pneumonia who were treated with medication and bronchial lavage were selected. We collected the results of laboratory and imaging examinations after admission, and the changes in lung consolidation area were examined by ultrasound before, immediately upon completion, and at 1, 3, and 7 days after bronchoalveolar lavage. The effective factors affecting bronchial lavage were analyzed through logistic regression. RESULTS Univariate regression analysis showed significant differences in the lung consolidation area at admission, before, immediately upon completion, and at 1 and 7 days after lavage, as well as in the disease course and atelectasis (or not). Multivariate analysis showed that there were statistical differences in the lung consolidation area at admission, atelectasis (or not), and disease course: lung consolidation area at admission [odds ratio (OR): 2.31512, 95% confidence interval (CI): (0.00182, 0.031775), P=0.029474], atelectasis [OR: 2.695742, 95% CI: (0.079281, 0.597218), P=0.012629], and disease course [OR: -2.43347, 95% CI: (-0.02568, -0.00211), P=0.022773]. CONCLUSIONS Lung ultrasound can evaluate the effect of bronchial lavage through lung consolidation and atelectasis, which can provide a reference for clinical treatment.
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Affiliation(s)
- Shuo Li
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qi-Li Zhang
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Rui-Jun Guo
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Zhang Lv
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xue Yang
- Department of Pediatrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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