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Clinical Management, Diagnosis and Treatment of Thoracic Diseases
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Clinical Management, Diagnosis and Treatment of Thoracic Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: closed (21 February 2025) | Viewed by 8428

Special Issue Editors

Dr. Damiano D'Ardes

E-Mail Website
Guest Editor
"Clinica Medica" Institute, Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
Interests: cardiovascular risk; lipid metabolism; metabolic diseases; ultrasound
Special Issues, Collections and Topics in MDPI journals
Dr. Andrea Boccatonda

E-Mail Website
Guest Editor
Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bologna, Italy
Interests: ultrasound; lung disease; hemostasis and thrombosis; cardiovascular disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thoracic diseases are among the most relevant and frequent pathologies in several areas of both the medical and surgical fields. In recent years, a change in the epidemiology of pulmonary diseases has occurred, with great interest in the field of infectious diseases. New diagnostic tools have made it possible to perform increasingly specific diagnoses. Moreover, new therapeutic options in both the medical and surgical fields are modifying the prognosis of some pathologies (e.g., neoplastic diseases). This Special Issue is aimed at all specialists involved in the management of lung diseases, and aims to highlight new diagnostic and therapeutic options in the field of chest diseases.

Dr. Damiano D'Ardes
Dr. Andrea Boccatonda
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung
  • thorax
  • pneumonia
  • chest
  • imaging
  • ultrasound

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Published Papers (6 papers)

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12 pages, 233 KiB  
Article
Cost-Effectiveness of Routine X-Rays After Central Venous Catheter Removal: A Value-Based Analysis of Post-Removal Complications
by Martin Breitwieser, Teresa Wiesner, Vanessa Moore, Florian Wichlas and Christian Deininger
J. Clin. Med. 2025, 14(4), 1397; https://doi.org/10.3390/jcm14041397 - 19 Feb 2025
Viewed by 591
Abstract
Background: Healthcare systems worldwide are increasingly burdened by rising costs, growing patient demand, and limited resources. In this context, cost-effectiveness analysis (CEA) plays a vital role in evaluating the clinical value of medical interventions relative to their costs. Despite the lack of [...] Read more.
Background: Healthcare systems worldwide are increasingly burdened by rising costs, growing patient demand, and limited resources. In this context, cost-effectiveness analysis (CEA) plays a vital role in evaluating the clinical value of medical interventions relative to their costs. Despite the lack of evidence supporting their necessity, routine post-removal chest X-rays for central venous catheters (CVCs) are still performed in some hospitals due to persistent misconceptions about their benefits. This study seeks to address these misconceptions by examining the costs of routine imaging through a cost analysis of complication detection rates in a large inpatient cohort, with the aim of highlighting the inefficiencies of this practice and promoting evidence-based approaches. Methods: A retrospective cohort analysis was performed across four university hospitals in Salzburg, Austria, including 984 CVC removals conducted between 2012 and 2021. Comparisons were made between X-rays after primary catheter insertion and post-removal X-rays to isolate complications specifically associated with CVC removal. A simple cost-per-outcome analysis, a subtype of CEA, was chosen to determine the cost per complication detected. The approach incorporated activity-based costing, adjusted to 2024 price levels via the Austrian Consumer Price Index (CPI), to capture real-world resource utilization. Results: Complications related to CVC removal were identified in five cases (0.5%), including one catheter rupture due to self-removal, two failed removals, one hemothorax, and one case of intrathoracic bleeding. Of these, three complications were detected on X-rays, including a retained catheter fragment, signs of intrathoracic bleeding, and a hemothorax. Additionally, one asymptomatic patient had a likely incidental finding of a small pneumothorax, which required no intervention. The cost of routine X-rays was calculated at EUR 38.20 per X-ray, resulting in a total expenditure of EUR 37,588.80 for 984 X-rays. This corresponds to EUR 7517.76 per detected complication (n = 4). The odds of detecting a complication on an X-ray were 193 times higher in symptomatic patients than in asymptomatic patients (p < 0.001). Conclusions: This study confirms that complications following CVC removal are rare with only five detected cases. Routine imaging did not improve clinical decision-making, as complications were significantly more likely to be identified in symptomatic patients through clinical evaluation alone. Given the high financial cost (EUR 37,588.80 for 984 X-rays, EUR 7517.76 per detected complication), routine post-removal X-rays are unnecessary in asymptomatic patients and should be reserved for symptomatic cases based on clinical judgment. Adopting a symptom-based imaging approach would reduce unnecessary healthcare costs, minimize patient radiation exposure, and optimize resource allocation in high-volume procedures such as CVC removal. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases)
10 pages, 559 KiB  
Article
SPECT/CT Accurately Predicts Postoperative Lung Function in Patients with Limited Pulmonary Reserve Undergoing Resection for Lung Cancer
by Isabelle Moneke, Christine von Nida, Oemer Senbaklavaci, Mirjam Elze, Philipp T. Meyer, Bernward Passlick, Christian Goetz and Laurin Titze
J. Clin. Med. 2024, 13(20), 6111; https://doi.org/10.3390/jcm13206111 - 14 Oct 2024
Cited by 1 | Viewed by 1118
Abstract
Background: Preoperative prediction of postoperative pulmonary function after anatomical resection for lung cancer is essential to prevent long-term morbidity and mortality. Here, we compared the accuracy of hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) with traditional anatomical and planar scintigraphy approaches in predicting [...] Read more.
Background: Preoperative prediction of postoperative pulmonary function after anatomical resection for lung cancer is essential to prevent long-term morbidity and mortality. Here, we compared the accuracy of hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) with traditional anatomical and planar scintigraphy approaches in predicting postoperative pulmonary function in patients with impaired lung function. Methods: We analyzed the predicted postoperative pulmonary function in patients undergoing major anatomical lung resection, applying a segment counting approach, planar perfusion scintigraphy (PPS), and SPECT/CT-based lung function quantification. Results: In total, 120 patients were evaluated, of whom 82 were included in the study. Postoperative lung function tests were obtained in 21 of 82 patients. The preoperative SPECT/CT-based quantification yielded very accurate results compared to the actual postoperative FEV1 and DLCO values. The linear regression analysis showed that the SPECT/CT-based analysis predicted postoperative FEV1 (%) and DLCO values more accurately than the segment counting approach or PPS. Accordingly, 58/82 patients would qualify for anatomical lung resection according to the SPECT-based quantification, 56/82 qualified according to the PPS (Mende), and only 47/82 qualified according to the segment counting method. Moreover, we noted that the SPECT-predicted FEV1 values were very close to the actual postoperative values in emphysema patients, and selected patients even showed improved lung function after surgery. Conclusions: Anatomically driven methods such as SPECT/CT yielded a very accurate prediction of the postoperative pulmonary function. Accordingly, applying SPECT/CT revealed more patients who would formally qualify for lung resection. We suggest SPECT/CT as the preferred method to evaluate eligibility for lung surgery in selected patients with impaired pulmonary reserve. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases)
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11 pages, 1422 KiB  
Article
Predicting Successful Weaning through Sonographic Measurement of the Rapid Shallow Breathing Index
by Eunki Chung, Ah Young Leem, Su Hwan Lee, Young Ae Kang, Young Sam Kim and Kyung Soo Chung
J. Clin. Med. 2024, 13(16), 4809; https://doi.org/10.3390/jcm13164809 - 15 Aug 2024
Cited by 1 | Viewed by 1725
Abstract
Background: Diaphragmatic dysfunction correlates with weaning failure, highlighting the need to independently assess the diaphragm’s effects on weaning. We modified the rapid shallow breathing index (RSBI), a predictor of successful weaning, by incorporating temporal variables into existing ultrasound-derived diaphragm index to create a [...] Read more.
Background: Diaphragmatic dysfunction correlates with weaning failure, highlighting the need to independently assess the diaphragm’s effects on weaning. We modified the rapid shallow breathing index (RSBI), a predictor of successful weaning, by incorporating temporal variables into existing ultrasound-derived diaphragm index to create a simpler index closer to tidal volume. Methods: We conducted a prospective observational study of patients who underwent a spontaneous breathing trial in the medical intensive care unit (ICU) at Severance Hospital between October 2022 and June 2023. Diaphragmatic displacement (DD) and diaphragm inspiratory time (Ti) were measured using lung ultrasonography. The modified RSBI was defined as follows: respiratory rate (RR) divided by DD was defined as D-RSBI, and RR divided by the sum of the products of DD and Ti on both sides was defined as DTi-RSBI. Results: Among the sonographic indices, DTi-RSBI had the highest area under the receiver operating characteristic (ROC) curve of 0.774 in ROC analysis, and a correlation was found between increased DTi-RSBI and unsuccessful extubation in a multivariable logistic regression analysis (adjusted odds ratio 0.02, 95% confidence interval 0.00–0.97). Conclusions: The DTi-RSBI is beneficial in predicting successful weaning in medical ICU patients. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases)
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16 pages, 6519 KiB  
Article
Unlocking Diagnostic Precision: FATE Protocol Integration with BLUE and eFAST Protocols for Enhanced Pre-Hospital Differential Diagnosis of Pleural Effusion Manifested as Dyspnea in Adults—A Pilot Study
by Damian Kowalczyk, Miłosz Turkowiak, Wojciech Jerzy Piotrowski, Oskar Rosiak and Adam Jerzy Białas
J. Clin. Med. 2024, 13(6), 1573; https://doi.org/10.3390/jcm13061573 - 9 Mar 2024
Cited by 1 | Viewed by 1920
Abstract
Background: Dyspnea commonly stems from combined myocardial and pulmonary dysfunction, posing challenges for accurate pre-hospital diagnosis. Limited diagnostic capabilities hinder the differentiation of cardiac and pulmonary issues. This study assesses the efficacy of combined cardiac and pulmonary ultrasound using the BLUE, eFAST, [...] Read more.
Background: Dyspnea commonly stems from combined myocardial and pulmonary dysfunction, posing challenges for accurate pre-hospital diagnosis. Limited diagnostic capabilities hinder the differentiation of cardiac and pulmonary issues. This study assesses the efficacy of combined cardiac and pulmonary ultrasound using the BLUE, eFAST, and FATE protocols. Methods: Participants were consecutively enrolled from dyspnea-related emergency calls in Warsaw, Poland, from 4 April 2022, to 15 June 2023. Patients with pleural effusion were identified through pre-hospital and in-hospital radiological assessments. Pre-hospital thoracic ultrasonography followed the BLUE, eFAST, and FATE protocols, alongside comprehensive clinical assessments. The pre-hospital diagnoses were juxtaposed with the with hospital discharge diagnoses. Results: Sixteen patients (8 men, 8 women; median age: 76 years) were enrolled. Inter-rater agreement for the BLUE protocol was substantial (κ = 0.78), as was agreement for eFAST (κ = 0.75), with almost perfect agreement for combined protocol assessment (κ = 0.83). Left ventricle hypokinesis, identified via the FATE protocol, significantly correlated with hospital-diagnosed decompensated heart failure as the primary cause of dyspnea. Sensitivity and specificity were 1.0 (95%CI: 0.62–1.0) and 0.6 (95%CI: 0.15–0.95), respectively. Positive predictive value was 0.85 (95%CI: 0.55–0.98), and diagnostic accuracy was 0.86 (95%CI: 0.62–0.98). Conclusions: Integrating the FATE protocol into BLUE and eFAST enhances pre-hospital differential diagnosis accuracy of pleural effusion in adults. This synergistic approach streamlines diagnostic processes and facilitates informed clinical decision-making. Larger-scale validation studies are needed for broader applicability. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases)
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11 pages, 1989 KiB  
Case Report
A 28-Year-Old Man with Stridor and Dyspnea
by Francesco Rocco Bertuccio, Davide Valente, Nicola Baio, Stefano Tomaselli, Laura Saracino, Gaetano Sciandrone, Alessandra Milanesi, Paolo Delvino, Veronica Codullo, Angelo Guido Corsico and Giulia Maria Stella
J. Clin. Med. 2025, 14(5), 1532; https://doi.org/10.3390/jcm14051532 - 25 Feb 2025
Viewed by 302
Abstract
Background: Tracheobronchial stenosis is a significant complication in granulomatosis with polyangiitis (GPA), a systemic vasculitis that primarily affects the upper respiratory tract, kidneys, and lungs. The involvement of the tracheobronchial tree in GPA leads to airway narrowing, which can result in severe respiratory [...] Read more.
Background: Tracheobronchial stenosis is a significant complication in granulomatosis with polyangiitis (GPA), a systemic vasculitis that primarily affects the upper respiratory tract, kidneys, and lungs. The involvement of the tracheobronchial tree in GPA leads to airway narrowing, which can result in severe respiratory symptoms and increased morbidity, often requiring prompt diagnosis and management to prevent life-threatening airway obstruction. Method: We present the case of a 28-year-old male with mild exertional dyspnea, stridor, and retropharyngeal sputum. Clinical investigations revealed subglottic and bronchial concentric stenosis with granulomatous inflammation. A diagnosis of granulomatosis with polyangiitis (GPA) with isolated tracheobronchial stenosis (TBS) was confirmed. Results: Given the severity of airway obstruction, multidisciplinary management was initiated, combining rigid bronchoscopy with systemic immunosuppressive therapy. Post-intervention follow-up demonstrated significant airway improvement and maintained remission after two years. Conclusions: This case highlights TBS as a potentially debilitating GPA manifestation requiring a combination of systemic and endoscopic therapies. Further studies are needed to optimize therapeutic approaches and improve outcomes in GPA-associated TBS. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases)
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20 pages, 5614 KiB  
Systematic Review
Role of Lung Ultrasound in the Detection of Lung Sequelae in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis
by Andrea Boccatonda, Damiano D’Ardes, Viola Tallarico, Maria Teresa Guagnano, Francesco Cipollone, Cosima Schiavone, Fabio Piscaglia and Carla Serra
J. Clin. Med. 2024, 13(18), 5607; https://doi.org/10.3390/jcm13185607 - 21 Sep 2024
Viewed by 2001
Abstract
Background: During the COVID-19 pandemic, several studies demonstrated the effectiveness of lung ultrasound (LUS) as a frontline tool in diagnosing and managing acute SARS-CoV-2 pneumonia. However, its role in detecting post-COVID-19 lung sequelae remains to be fully determined. This study aims to [...] Read more.
Background: During the COVID-19 pandemic, several studies demonstrated the effectiveness of lung ultrasound (LUS) as a frontline tool in diagnosing and managing acute SARS-CoV-2 pneumonia. However, its role in detecting post-COVID-19 lung sequelae remains to be fully determined. This study aims to evaluate the diagnostic accuracy of LUS in identifying lung parenchymal damage, particularly fibrotic-like changes, following COVID-19 pneumonia, comparing its performance to that of CT. Methods: Relevant studies published before July 2024 were identified through a comprehensive search of PubMed, Embase, and Cochrane library. The search terms were combinations of the relevant medical subject heading (MeSH) terms, key words and word variants for “lung”, “post-COVID”, “long-COVID”, and “ultrasound”. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curve were used to examine the accuracy of CEUS. The selected works used different thresholds for the detection and counting of B-lines by ultrasound. This led to dividing our analysis into two models, the first based on the lower thresholds for detection of B-lines found in the works, and the second on data obtained using a higher detection threshold. Results: In terms of the diagnostic accuracy of LUS in detecting residual fibrotic-like changes in patients post-COVID-19 infection, a low-threshold model displayed a pooled sensitivity of 0.98 [95% confidence interval (CI): 0.95–0.99] and a pooled specificity of 0.54 (95% CI: 0.49–0.59). The DOR was 44.9 (95% CI: 10.8–187.1). The area under the curve (AUC) of SROC was 0.90. In the second analysis, the model with the higher threshold to detect B-lines showed a pooled sensitivity of 0.90 (95% CI: 0.85–0.94) and a pooled specificity of 0.88 (95% CI: 0.84–0.91). The DOR was 50.4 (95% CI: 15.9–159.3). The AUC of SROC was 0.93. Conclusions: In both analyses (even using the high threshold for the detection of B-lines), excellent sensitivity (98% in model 1 and 90% in model 2) is maintained. The specificity has a significant variation between the two models from 54 (model 1) to 87% (model 2). The model with the highest threshold for the detection of B-lines displayed the best diagnostic accuracy, as confirmed by the AUC values of the SROC (0.93). Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases)
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