Open research questions in Pleural and Pulmonary Diseases

What the literature leaves open

• Haemothorax is a rare but potentially life-threatening complication of PCNL. Massive haemothorax with occult presentation poses a diagnostic challenge.

  Case Report: Point-of-care ultrasound-guided rescue of massive haemothorax after percutaneous nephrolithotomy · 2026 · DOI

• Diagnostic challenges due to nonspecific clinical features. Delayed diagnosis due to pre-existing urinary tract malformations. Need for prompt pleural fluid analysis and timely urologic intervention.

  Pediatric Urinothorax Presenting as Refractory Pneumonia and Empyema · 2026 · DOI

• The challenges include the high rate of complications associated with chest drain placement in trapped lung. The lack of pleural manometry in the Emergency Department may limit the ability to diagnose lung non-expandability.

  Massive subcutaneous emphysema and the “sentinel hole” phenomenon after chest drain placement in neoplastic trapped lung: a case report from the emergency department · 2026 · DOI

• The importance of the diaphragm in post-cardiac surgery pleural effusion is often overlooked. There is a need for effective inspiratory training programs to improve diaphragmatic function in patients with pleural effusion.

  Post-cardiac Surgery Pleural Effusion and the Overlooked Importance of the Diaphragm: Setting Up an Inspiratory Training Program Correctly · 2026 · DOI

• There has been no similar pediatric study on the incidence of parapneumonic effusion. The study aims to fill this gap by providing a description of the incidence and characteristics of parapneumonic pleural effusion and empyema in children.

  Parapneumonic Pleural Effusion and Empyema in Children · 1983 · DOI

• The possibility of BPF in patients with lower risk factors is not clearly evident in literature. Most studies focus on traditional high-risk populations.

  Sub-threshold hypoalbuminemia, anemia, and occult infection trigger post-lobectomy bronchopleural fistula: a case report · 2026 · DOI

• The working channel and hemostatic options are limited compared to standard pleuroscopy or VATS. The procedure should be aborted and converted to standard pleuroscopy or VATS if visualization cannot be maintained or if pleural adhesions prevent continuous cavity navigation.

  Single-use bronchoscopes for pleural cavity access: cadaveric feasibility study · 2026 · DOI

• Clinical validation of these techniques in a stepwise manner. Assessment of the diagnostic yield and complication profiles of these approaches compared to conventional methods.

  Single-use bronchoscopes for pleural cavity access: cadaveric feasibility study · 2026 · DOI

• The low specificity of the clinical course and minimal bacterial shedding lead to diagnostic delays. The effectiveness of pharmacotherapy largely depends on the stability of the availability of anti-tuberculosis drugs. The study identifies gaps in the availability of fixed combinations and pediatric forms.

  Surgical clinic for the treatment of tuberculous exudative pleurisy: availability of anti-tuberculosis drugs · 2026 · DOI

• There is a lack of direct comparative data on the optimal modes, duration, and role of fixed combinations for pleural localizations. There is a need for the development of treatment protocols that take into account the availability of anti-tuberculosis drugs.

  Surgical clinic for the treatment of tuberculous exudative pleurisy: availability of anti-tuberculosis drugs · 2026 · DOI

• The main limitation of this report is that it is a retrospective review of a single patient case, which limits the generalizability of the study’s findings. Furthermore, the imaging characteristics and biomarkers associated with occult lung cancer that primarily manifests as SP combined with bullous emphysema or emphyse- matous changes on imaging have not been extensively described, which could provide insights into understanding the tumor biology further. Another significant limitation of this report is the absence of long-term follow-up data for the patient. Currently, the patient has been monitored for 16 months postoperatively without recurrence. The surveillance protocol consisted of contrast-en- hanced chest CT scans and serum tumor marker evaluations performed every 6 months during the first year, and scheduled annually thereafter. Given the limited duration of follow-up, we are unable to evaluate the patient’s long-term prognosis, the durability of the surgical intervention, or the potential for lung cancer recurrence or progression.

  Secondary spontaneous pneumothorax as an initial manifestation of lung cancer: a case report · 2026 · DOI

• Urinothorax is an under-recognized clinical entity in children. There is a need for increased awareness of urinothorax in the differential diagnosis of pleural effusion in children with urinary tract anomalies.

  Pediatric Urinothorax Presenting as Refractory Pneumonia and Empyema · 2026 · DOI

• Bronchogenic lung abscess complicated by bronchoperitoneal fistula is a rare and potentially life-threatening condition. There is a need for early recognition and treatment of this condition.

  Left-Sided Lung Abscess, Complicated with Bronchoperitoneal Fistula: Case Report · 2026 · DOI

• The literature rarely describes the specific mechanism of subcutaneous emphysema propagation related to proximal chest tube fenestration migration. There is a need for more research on the management of MPE in the Emergency Department, particularly in patients with trapped lung.

  Massive subcutaneous emphysema and the “sentinel hole” phenomenon after chest drain placement in neoplastic trapped lung: a case report from the emergency department · 2026 · DOI

• There is a lack of awareness about the potential for malpositioned chest tubes. The importance of vigilant evaluation of complex patients with lines, drains, and airways is not well emphasized.

  Pigtail catheter found in the Lingula of a pediatric patient on VV-ECMO while performing flexible bronchoscopy: a case report on an unexpected finding · 2026 · DOI

• The close anatomical relationship between the brachial plexus and the pleura at the supraclavicular level can increase procedural complexity and risk of complications. There is a need to identify modifiable anatomical factors that can influence anatomical conditions relevant to ultrasound-guided supraclavicular procedures.

  Lateral Decubitus Positioning Increases Pleura–Plexus Distance in Ultrasound-Guided Supraclavicular Brachial Plexus Targeting · 2026 · DOI

• Reports of patients who remain hemodynamically stable throughout surgery but experience abrupt hemothorax progression immediately after emergence from general anesthesia are rare.

  Sudden exacerbation of a minimal hemothorax during emergence from general anesthesia: diagnosis using lung ultrasound · 2026 · DOI

• Thus, POCUS serves as a valuable tool may not be generalizable across sexes or to broader patient for minimizing diagnostic delays and facilitating rapid ther- populations.

  Sudden exacerbation of a minimal hemothorax during emergence from general anesthesia: diagnosis using lung ultrasound · 2026 · DOI

• The study identifies a gap in the current understanding of non-bronchial systemic arteries in patients with pulmonary tuberculosis complicated by massive hemoptysis. The study highlights the need for further research on the risk factors and treatment of NBSA occurrence.

  Non-bronchial systemic arteries in massive hemoptysis secondary to pulmonary tuberculosis: risk factors and outcomes of embolization materials. A retrospective observational study · 2026 · DOI

• Iatrogenic pneumothorax incidence is noted as high and increasing following percutaneous lung biopsy, transbronchial needle aspiration, pleural biopsy, thoracocentesis, and central venous puncture, with COPD and lung fibrosis identified as risk factors. However, specific incidence rates, risk stratification tools, and preventive strategies for each procedure type are not provided.

  Pleural disease in respiratory medicine · 2020 · DOI

• Digital suction devices are mentioned as potentially helpful for accurately delivering suction and recording air leak volume in secondary pneumothorax with persistent air leak, but clinical trial data comparing digital suction delivery versus manual titration to optimal negative pressure levels (down to -20 cmH2O) are absent.

  Pleural disease in respiratory medicine · 2020 · DOI

• No structured protocol is presented for assessing and monitoring diaphragmatic integrity during foreign body removal in self-stabbing cases; future work should develop imaging criteria and intraoperative inspection guidelines to detect diaphragm injuries in thoracic self-harm cases.

  Two Self-Stabbing Pneumothorax Cases · 2018 · DOI

• The paper does not establish standardized criteria for when VATS (Video-Assisted Thoracoscopic Surgery) should be employed versus open thoracotomy in self-inflicted penetrating lung injuries with embedded foreign bodies; controlled comparison of surgical approaches for knife extraction from specific lung segments (medial segment lower lobe) is lacking.

  Two Self-Stabbing Pneumothorax Cases · 2018 · DOI

• There is a lack of consensus about the drug of choice for fibrinolytic therapy, so this study was designed to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema.

  A retrospective study to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema · 2024 · DOI

• The long latency period (nine years of acebutolol use before manifestation) and variable presentation time suggest a need for prospective studies to determine risk factors and timeline for development of this adverse effect.

  Acebutolol-Induced Massive Pleural Thickening · 2019 · DOI

Most-cited papers in Pleural and Pulmonary Diseases

• Pneumothorax Following Thoracentesis · Archives of Internal Medicine · 2010 · 260 citations
• Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients · Tuberkuloz ve Toraks · 2023 · 4 citations
• Clinical importance of serum and pleural fluid prominin-1 and hypoxia-inducible factor-1α concentration in the evaluation of lymph node involvement in patients with malignant pleural effusion · Biochemia Medica · 2023 · 3 citations
• ADA as main biochemical marker in patients with tuberculous effusion · Journal of Medical Biochemistry · 2023 · 3 citations
• Left ventricular perforation by a chest tube: Case report and review of complications · Heart Vessels and Transplantation · 2024 · 3 citations
• The importance of early diagnosis and treatment of incidental tension pneumothorax during robotic assisted laparoscopy for diaphragmatic endometriosis: a report of two cases. · Facts Views and Vision in ObGyn · 2021 · 3 citations
• Unraveling the mystery of pleural calcifications: a diagnostic challenge in pleural disease · Archives of Medical Science - Atherosclerotic Diseases · 2025 · 3 citations
• Development and content validation of the checklist for assessing placement of a small‐bore chest tube (<scp>CAPS)</scp> for small‐bore chest tube placement · AEM Education and Training · 2023 · 3 citations
• A retrospective study to evaluate the safety and efficacy of intrapleural alteplase in pediatric empyema · Przeglad Epidemiologiczny · 2024 · 2 citations
• Difficulty in thoracic catheter insertion in a very obese patient · Tuberkuloz ve Toraks · 2021 · 2 citations

Most recent work

• Safety and Efficacy of Single-Stage Synchronous Bilateral VATS Talc Poudrage for Malignant Pleural Effusion · Cancers · 2026
• Diagnostic Accuracy of Light’s Criteria, Alkaline Phosphatase, Total Cholesterol, and D-dimer in Differentiating Transudative and Exudative Pleural Effusion: A Cross-sectional Study · NATIONAL JOURNAL OF LABORATORY MEDICINE · 2026
• Bypassing pleural aspiration for early tissue diagnosis in suspected pleural malignancy: Development and external validation of a predictive model using supervised machine learning · Qatar Medical Journal · 2026
• Development of immunoassays targeting Mycobacterium tuberculosis antigens Ag85A, CFP-10, BfrB, and ESAT-6 in paired pleural fluid and urine samples for the diagnosis of pleural tuberculosis · Mycobacteria · 2026
• Sub-threshold hypoalbuminemia, anemia, and occult infection trigger post-lobectomy bronchopleural fistula: a case report · Frontiers in Medicine · 2026
• Performance Validation and Clinical Utility of a Smartphone-Based Colorimetric System for Differentiating Exudative and Transudative Pleural Effusions and Ascites via Total Protein Quantification · Annals of Clinical Biochemistry: International Journal of Laboratory Medicine · 2026
• Comparison of the diagnostic accuracy of interleukin-27 and adenosine deaminase for tuberculous pleural effusion: A systematic review and meta-analysis with head-to-head design · Cytokine · 2026
• Single-use bronchoscopes for pleural cavity access: cadaveric feasibility study · General Thoracic and Cardiovascular Surgery · 2026
• Thoracostomy in the Surgical Treatment of Patients with Pleural Empyema and Upper Gastrointestinal Fistulas · Russian Sklifosovsky Journal "Emergency Medical Care" · 2026
• Postoperative pain management after VATS for spontaneous pneumothorax - a systematic review · BMC Anesthesiology · 2026

Related topics in Medicine