eComment. A pocket-sized imaging device during a minimally invasive pleural biopsy.

recess in the case of both mild PE and abundant PE. Our study has shown that this calculation can be done directly at the bedside without any radiation risk and it can improve the efficacy and safety of the decision making regarding patients with PE before thoracentesis. Conclusions A PSID is a useful tool that may integrate and complete the physical examination and may also provide additional information to chest X-ray for the clinical management of patients with suspected PE. The PSID-derived estimates regarding the nature and quantity of PE may be applied in the decision making of thoracentesis, and the use of PSID increases the effectiveness and safety of the procedure. et al.. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study. We read with great interest the innovative work by Lisi et al. regarding the value of a pocket-sized imaging device (PSID) for the bedside diagnosis of pleural effu-sions and ultrasound-guided thoracentesis [1]. We think that the use of PSIDs could be extended to minimally invasive pleural biopsies, if the diagnosis by simple thoracentesis is not sufficient. Apart from the standard methods of pleural biopsy, we have recently published a simple method of simultaneous chest tube drainage and minimally invasive pleural biopsy with the use of the mediastinoscope [2]. The technique is simple and is carried out under local anaesthesia. It is performed with the patient in either the supine or the lateral position. During the routine process of chest tube insertion, after the dissection of the intercostal muscles, a standard mediastinoscope is inserted to inspect the outer aspect of the adjacent parietal pleura. The parietal pleura can be detached from the chest wall by a small gauze in the forceps of the mediastinoscopy set. It can alternatively be performed blindly with a finger, or both techniques can be used. Then, biopsies of the adjacent parietal pleura are taken by using the biopsy forceps from the Figure 8: Three examples of increasing degree of pleural effusion (PE), illustrating the method of ultrasound estimation of PE obtained through the pocket-sized imaging device: a mild PE (A), a moderate PE (B) and a severe PE (C). Abbreviations and symbols: VP represents the distance between the diaphragm and visceral pleura; BL represents the bisector line of the costodiaphragmatic recess.