title: Advanced medical interventions in pleural disease.
abstract: The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.
authors.affiliation: Academic Respiratory Unit, University of Bristol, Bristol, UK These authors contributed equally.
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhatnagar
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK These authors contributed equally jpcorcoran@doctors.org.uk.
authors.forename: John P
authors.initials: JP
authors.lastname: Corcoran
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Fabien
authors.initials: F
authors.lastname: Maldonado
authors.affiliation: Division of Pulmonary and Critical Care Medicine, John Hopkins University, Baltimore, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Julius
authors.initials: J
authors.lastname: Janssen
authors.affiliation: Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
authors.forename: Najib M
authors.initials: NM
authors.lastname: Rahman
mesh_terms: D000818:Animals; D003948:Diagnostic Techniques, Respiratory System / Q000639:trends*; D004059:Diffusion of Innovation; D005544:Forecasting; D006801:Humans; D010995:Pleural Diseases / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D015272:Pulmonary Medicine / Q000639:trends*