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Open research questions in Pleural and Pulmonary Diseases

88 gap statements mined from Pleural and Pulmonary Diseases papers in our 4.5M-paper local library, which holds 480 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.

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What the literature leaves open

  • Future research should focus on standardising these biomarkers through prospective trials and integrating them into established clinical decision-making frameworks alongside Light’s criteria to improve PE management.

    Diagnostic Accuracy of Light’s Criteria, Alkaline Phosphatase, Total Cholesterol, and D-dimer in Differentiating Transudative and Exudative Pleural Effusion: A Cross-sectional Study · 2026 · DOI

  • The lack of a rigorous definition and evaluation of interpretability in machine learning. The need for a taxonomy that links application-grounded, human-grounded, and functionally-grounded approaches. The challenge of human-subject experiments and the need for careful consideration in interpretability research.

    Bypassing pleural aspiration for early tissue diagnosis in suspected pleural malignancy: Development and external validation of a predictive model using supervised machine learning · 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

  • 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

  • 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

  • Balancing the need for effective symptom relief with the potential risks and complications of the procedure.

    Safety and Efficacy of Single-Stage Synchronous Bilateral VATS Talc Poudrage for Malignant Pleural Effusion · 2026 · DOI

  • Limited evidence regarding synchronous bilateral pleurodesis in patients with bilateral MPE. Need for further prospective studies to confirm the findings and refine patient selection. Limited understanding of the long-term outcomes of synchronous bilateral VATS talc pleurodesis.

    Safety and Efficacy of Single-Stage Synchronous Bilateral VATS Talc Poudrage for Malignant Pleural Effusion · 2026 · DOI

  • 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

  • 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 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

  • The complexity of the patient's condition, which required multiple interventions. The need for repeated evaluation and prompt change in therapy when there is incomplete source control.

    Diagnostic challenges in boerhaave syndrome with bilateral pleural contamination: complementary roles of computed tomography, endoscopy, and video-assisted thoracoscopic surgery · 2026 · DOI

  • The lack of age-specific management recommendations or guidelines for pediatric PSP. The need for a clinical scoring system specifically designed for pediatric PSP management.

    Proposal of a new tool for paediatric primary spontaneous pneumothorax: the Spontaneous Pneumothorax in Adolescents and Children Evaluation (SPACE) score · 2026 · DOI

  • TRACP is traditionally defined as a specific marker of osteoclast activity, widely used in the diagnosis and monitoring of bone metabolic diseases such as osteoporosis and bone tumors, and its role in acute thoracic injury has not been reported (17).

    Dynamic analysis of 22 serum biomarkers following pneumothorax · 2026 · DOI

  • The diagnostic accuracy of conventional pleural fluid microbiology is limited by the paucibacillary nature of TBP, prompting greater use of pleural biopsy and medical thoracoscopy, which improve microbiological and histological yield.

    State of the art: practical evaluation and management of tuberculous pleural effusion · 2026 · DOI

  • A simple clinical composite score offers higher specificity but remains insufficiently sensitive to be used as a standalone diagnostic tool; it may support field decision-making as a risk-stratification aid, but prehospital clinical signs alone are not sufficient to rule out a pneumothorax requiring early decompression.

    Prehospital diagnostic performance of emergency physicians in identifying blunt traumatic pneumothorax requiring early decompression · 2026 · DOI

  • Combining the diagnostic and therapeutic efficacy of medical thoracoscopy and poudrage with the ambulatory benefits of an IPC has not been studied within a randomised controlled trial.

    Medical thoracoscopy with talc poudrage and indwelling pleural catheter insertion versus medical thoracoscopy with talc poudrage alone for patients with symptomatic malignant pleural effusion (TACTIC): a randomised, controlled phase 3 trial · 2026 · DOI

  • Compared to respiratory trainees, non-respiratory trainees perform lower numbers of Seldinger CTI, with lower confidence levels, limited knowledge, and a reduced perceived relevance of the skill set.

    Training, experience, and perceptions of chest tube insertion by higher speciality trainees: implications for training, patient safety, and service delivery · 2024 · DOI

  • The diagnostic performance of the frontline polymerase chain reaction–based GeneXpert MTB/RIF Ultra (Xpert Ultra) remains suboptimal (sensitivity of ∼30%), but data are limited.

    Diagnostic Performance of Unstimulated IFN-γ (IRISA-TB) for Pleural Tuberculosis: A Prospective Study in South Africa and India · 2024 · DOI

  • Second, we agree that there is uncertainty surrounding the diagnosis of interstitial lung disease (ILD) when ILAs are identified on computed tomographic scans in clinical settings, because clear criteria are lacking, and these categories may represent a spectrum of ILD development and progression.

    MIST-3 Is Well Worth an Echo! · 2024 · DOI

  • Computed tomography (CT) is routinely employed on the evaluation of dyspnea, yet limited data exist on its assessment of diaphragmatic muscle.

    Evaluation of computed tomography in the diagnosis of ultrasound-proven diaphragm dysfunction · 2024 · DOI

  • Furthermore, the imaging characteristics and biomarkers associated with occult lung cancer that primarily manifests as SP combined with bullous emphysema or emphysematous changes on imaging have not been extensively described, which could provide insights into understanding the tumor biology further.

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

Most-cited papers in Pleural and Pulmonary Diseases

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Open questions raised by papers listed on this page include: (1) Future research should focus on standardising these biomarkers through prospective trials and integrating them into established clinical decision-making frameworks alongside Light’s criteria to improve PE management (“Diagnostic Accuracy of Light’s Criteria, Alkaline Phosphatase, Total…”, 2026); (2) The lack of a rigorous definition and evaluation of interpretability in machine learning (“Bypassing pleural aspiration for early tissue diagnosis in suspected pleural…”, 2026); (3) There is a lack of direct comparative data on the optimal modes, duration, and role of fixed combinations for pleural localizations (“Surgical clinic for the treatment of tuberculous exudative pleurisy:…”, 2026); (4) 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…”, 2026); (5) There is a lack of awareness about the potential for malpositioned chest tubes (“Pigtail catheter found in the Lingula of a pediatric patient on VV-ECMO while…”, 2026). 88 gap statements have been mined from Pleural and Pulmonary Diseases papers in our 4.5M-paper local library, which holds 480 papers on the topic; the gaps come from whichever of those papers state one. They are mostly the research gaps the authors state and the papers' abstracts, plus future-work, limitations and challenges passages. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one, so you can read the original claim in context.

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