Thoracic Oncology
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Lung ultrasound: An indispensable yet underutilized tool
An assessment using bedside thoracic ultrasound (TUS) improves diagnostic evaluation and therapeutic management in critically ill patients without undue risk. With changes in diagnosis occurring in 23% of cases and alterations in management in 39% of critically ill patients, TUS can improve length of stay, reduce complications, minimize delays in therapy, and lower hospitalization costs.1…
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Atypical pulmonary cysts: Why to care
Since the American College of Radiology (ACR) updated its Lung CT Screening Reporting & Data System (Lung-RADS) to include atypical pulmonary cysts in 2022, there has been little discussion among chest physicians regarding the significance of pulmonary cysts and why these changes were made. Lung-RADS 2022 defined atypical pulmonary cysts as single, unilocular cysts with…
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Diagnostic yield reporting of bronchoscopic peripheral pulmonary nodule biopsies: A call for standardization
More than 1.5 million Americans are diagnosed with an incidental CT scan-detected lung nodule annually. Advanced bronchoscopy, as a diagnostic tool for evaluation of these nodules, has evolved rapidly, incorporating a range of techniques and tools beyond CT scan-guided biopsies to assess peripheral lesions. The primary goal is to provide patients with accurate benign or…
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Electrical impedance tomography: Visualization and integration of the impact of mechanical ventilation
Lung protective ventilation (LPV) is the cornerstone to minimizing ventilator-induced lung injury. Hence, LPV is associated with better survival in patients both with and without ARDS.1 2 3 Continuous monitoring of the tidal volume, plateau pressure, and positive end-expiratory pressure (PEEP) is crucial to maintain LPV. Electrical impedance tomography (EIT) is a noninvasive, radiation-free, imaging…
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Primary vs secondary: A review of pneumothorax management
Optimal management of primary spontaneous (PSP) and secondary spontaneous pneumothorax (SSP) remains an area of ongoing debate, with both CHEST and the British Thoracic Society (BTS) offering guidelines to address management decisions. The consensus for treatment of PSP depends on the size of the pneumothorax; if smaller than 2-3 cm, the patient can be observed…
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A word of caution on e-cigarettes: Retracted paper
Editor’s note: On March 29, 2024, the authors of the study, “Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial,” published in JAMA Internal Medicine, issued a formal retraction of their article. The CHEST Physician Editorial Board apologizes for any confusion this may have…
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Transesophageal ultrasound: The future of ultrasound in the ICU
Historically, transesophageal ultrasound (TEE) has been regarded as a diagnostic and management tool for structural heart disease in relatively stable patients. However, TEE is more commonly being utilized by intensivists as a first-line tool in the diagnostics and management of patients in the ICU. TEE, with its unobstructed superior cardiac views, facilitates rapid diagnosis in…
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CHEST grant recipient studying increase in lung cancer diagnoses among Chinese American women
In his prior research, Chien-Ching Li, PhD, MPH, focused on promoting lung cancer screening in Chinese American men, a population that frequently smokes heavily. But last year, he applied for a CHEST grant that’s shifting his focus to another demographic: Chinese American women who do not smoke, especially those with limited English proficiency. “They are…
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Nurturing health equity in smoking cessation care
Lung cancer stands as the leading cause of cancer-related deaths globally, with its prevalence casting a long and challenging shadow. The most important risk factor for lung cancer is tobacco use, a relationship strongly substantiated by data. The impact of smoking cessation to reduce lung cancer incidence is underscored by the US Preventive Services Task…
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Biomarker checklist seeks to expedite NSCLC diagnoses
Establishing a systematic biomarker testing program for patients with suspected non-small cell lung cancer (NSCLC) takes both time and collaboration across specialties. To standardize this process, the American College of Chest Physicians (CHEST) created two clinician checklists for use in practice. The case-by-case checklist helps guide physicians to ensure timely and comprehensive biomarker testing for…
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Examining the past and looking toward the future: The need for quality data in interventional pulmonology
During the last decade, the explosion of technological advancements in the field of interventional pulmonary (IP) has afforded patients the opportunity to undergo novel, minimally invasive diagnostic and therapeutic procedures. However, these unprecedented technological advances have often been introduced without the support of high-quality research on safety and efficacy, and without evaluating their impact on…
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Thoracic ultrasound advancements for the assessment and management of pleural disorders
Thoracic ultrasound (TUS) is standard of care for the detection of pleural effusion and guidance of pleural procedures. Recent advancements have further expanded the utility of TUS. TUS has better diagnostic performance than CT scan or chest radiograph for predicting complicated parapneumonic effusion (Svigals PZ, et al. Thorax. 2017;72[1]:94-5). This is likely because of better…
