Purpose of review: Medical thoracoscopy, also known as pleuroscopy, has been utilized by chest physicians for more than a century. Despite this, it has only recently re-emerged as an important tool for interventional pulmonologists to diagnose and treat pleural diseases. The purpose of this review is to critically assess the recent literature related to medical thoracoscopy, specifically as it pertains to its safety and feasibility as an outpatient procedure. Recent findings: Recent data have reaffirmed the clinical utility of medical thoracoscopy and suggest that it can be safely performed in an outpatient setting. A single-center study of 51 patients published in the past year described both the feasibility and safety of outpatient medical thoracoscopy. This study highlights the notion that the majority of patients do not require hospital admission after a routine diagnostic thoracoscopy in the absence of talc poudrage. Another study this year described the successful use of chest physician-directed ultrasound-guided cutting needle biopsy when medical thoracoscopy was not technically possible. Summary: The contribution of medical thoracoscopy in the diagnosis and management of pleural diseases is increasingly recognized. Evidence supports the routine practice of medical thoracoscopy on an outpatient basis in experienced centers.

Purpose of review: Imaging plays an important role in the diagnosis and optimal treatment of patients with pleural diseases. MRI is a noninvasive imaging modality, which is not commonly used as first-line investigation in this field, but is often called upon to solve specific dilemmas. In this review, the basic methodology of MRI and its usefulness in pleural diseases will be explored. Recent findings: Recent advances in MRI technology have allowed the application of novel sequences, not only for anatomical but also for functional imaging. Improvement was mainly achieved by means of diffusion-weighted and dynamic contrast-enhanced MRI. These sequences can be used not only for detection, but also for characterization of pleural lesions. Even detection of pleural tumor recurrence and treatment response monitoring is possible. Summary: The use of conventional and functional MR sequences has led to improvements in the detection and characterization of pleural diseases. This technique, whether or not in combination with SPECT and PET (so called multimodality approach), could be an added value in the near future.

Purpose of review: Pleural effusion is a common clinical problem resulting from a wide range of diseases. Treatment options include targeting the primary cause or, in persistent cases, invasive removal of the excess fluid from the pleural cavity. In this review, we summarize the experimental data concerning pharmacological agents that influence pleural fluid resorption and examine their potential as a novel noninvasive treatment strategy. Recent findings: Recently published evidence indicates that adrenergic agents and corticosteroids can increase pleural fluid clearance from the cavity. On the contrary, paracetamol and certain nonsteroid anti-inflammatory drugs can impede fluid outflow. These concepts are based on data extracted by in-vivo studies using provoked hydrothoraces in rabbits and mice, as well as by ex-vivo electrophysiological experiments using sheep and human pleural tissue. Summary: In conclusion, the available experimental data indicate that certain pharmacological agents may impact fluid resorption, thus affecting pleural fluid accumulation and the rate of pleural effusion resolution.

Purpose of review: The aim of this review is to provide an outline of current evidence for the use of F-18-fluoro-deoxy-glucose PET computed tomography (FDG-PET/CT) in nonsmall cell lung cancer (NSCLC) for diagnosis, staging, radiotherapy planning, response assessment and response monitoring. Recent findings: Management of patients with NSCLC requires a multimodality approach to accurately diagnose and stage patients. In this approach, FDG-PET/CT has become a standard staging instrument in lung cancer. FDG-PET/CT is, in addition to staging, also valuable for the characterization of the solitary pulmonary nodule. An increased uptake in the nodule as compared with mediastinal blood pool is suspected for malignancy. In radiotherapy planning, FDG-PET/CT can assist the radiation oncologist for optimal dose delivery to the tumour, while sparing healthy tissues. Evidence of the prognostic and predictive implications of FDG-PET/CT is accumulating. Volumetric parameters of PET, such as metabolic active tumour volume and total lesion glycolysis, are promising predictive and prognostic biomarkers. However, for implementation of metabolic response parameters in clinical practice, more randomized, PET-based, multicentre trials are necessary. The introduction of integrated PET and MRI scanners did not change the pivotal role of standard FDG-PET/CT yet, as with current technology, PET/MRI did not show superior performance in thoracic staging. Summary: The role of PET is described for diagnosis, staging and response assessment.