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The authors of a study on ultrasound-guided pleural biopsies respond to comments by Dr. Liang and colleagues concerning incidences of pneumothorax as a complication. They clarify that their reported data only involves biopsies of pleura in patients with pleural effusions, with lung parenchyma being avoided, which reduces the occurrence of pneumothorax. They emphasize that the pneumothorax rates indicated in referenced studies involve different types of biopsies, with some including CT-guided lung biopsies, unlike their focus on pleura alone using ultrasound guidance. They note that patients with severe COPD are generally not chosen for medical thoracoscopy due to various health constraints, potentially influencing pneumothorax occurrence.<br /><br />Additionally, the response addresses Dr. Liang's concerns over patients "failing thoracoscopy" by reiterating factors contributing to this, as previously described in their publication. These include patient frailty and issues like heavily loculated pleural fluid. They highlight that ultrasound-guided biopsy remains effective in such scenarios for diagnostic purposes.<br /><br />Regarding the suggestion of overnight admission post-procedure, the authors note a lack of robust evidence to support this practice specifically for ultrasound-guided pleural biopsies. They defend the practice of a 1-hour observation period post-procedure, common in the UK for day-case procedures, bolstered by their experience of over 3,000 procedures in recent years, which has been adequate for identifying any arising complications.<br /><br />The article concludes with affirmations of no conflicts of interest and provides correspondence details for the lead author, Robert J. Hallifax.
Keywords
ultrasound-guided pleural biopsies
pneumothorax complication
pleural effusions
lung parenchyma
CT-guided lung biopsies
medical thoracoscopy
severe COPD
thoracoscopy failure
overnight admission
post-procedure observation
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