Differentiate pleural effusion from hemothorax after blunt chest trauma; comparison of computed tomography attenuation values

Liu, Fusoon; Huang, Ying; Ng, Yu-Bun; Liang, Joseph Hang

doi:10.1016/j.jacme.2015.12.001

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…A manual search of references from these studies and reviews did not yield any additional records. A total of 22 were excluded (see Table A1) after full-text assessment for the following reasons: No diagnostic accuracy design [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (n = 18), no empyema in the study collective [41] (n = 1), case-report [42] (n = 1), no reference test [43] (n = 1), and empyema as negative collective [44].…”

Section: Study Selectionmentioning

confidence: 99%

Diagnostic Accuracy of Imaging Findings in Pleural Empyema: Systematic Review and Meta-Analysis

et al. 2021

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Computed tomography (CT) diagnosis of empyema is challenging because current literature features multiple overlapping pleural findings. We aimed to identify informative findings for structured reporting. The screening according to inclusion criteria (P: Pleural empyema, I: CT C: culture/gram-stain/pathology/pus, O: Diagnostic accuracy measures), data extraction, and risk of bias assessment of studies published between 01-1980 and 10-2021 on Pubmed, Embase, and Web of Science (WOS) were performed independently by two reviewers. CT findings with pooled diagnostic odds ratios (DOR) with 95% confidence intervals, not including 1, were considered as informative. Summary estimates of diagnostic accuracy for CT findings were calculated by using a bivariate random-effects model and heterogeneity sources were evaluated. Ten studies with a total of 252 patients with and 846 without empyema were included. From 119 overlapping descriptors, five informative CT findings were identified: Pleural enhancement, thickening, loculation, fat thickening, and fat stranding with an AUC of 0.80 (hierarchical summary receiver operating characteristic, HSROC). Potential sources of heterogeneity were different thresholds, empyema prevalence, and study year.

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Section: Study Selectionmentioning

confidence: 99%

Diagnostic Accuracy of Imaging Findings in Pleural Empyema: Systematic Review and Meta-Analysis

et al. 2021

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“…Although there is a small overlap, pleural fluid of a density > 15.6 HU is likely a result of hemothorax rather than simple effusion. 12 The post-biopsy pleural fluid density in our case was higher than this threshold and hemothorax should have been suspected. Early intervention to achieve hemostasis, such as surgical intervention or transarterial embolization, might be possible to avoid morbidity or mortality.…”

Section: Discussionmentioning

confidence: 47%

“…Acute post‐biopsy pleural effusion might be attributed to a similar mechanism as trauma to the pleura. Although there is a small overlap, pleural fluid of a density > 15.6 HU is likely a result of hemothorax rather than simple effusion . The post‐biopsy pleural fluid density in our case was higher than this threshold and hemothorax should have been suspected.…”

Section: Discussionmentioning

confidence: 58%

Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

et al. 2018

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Intercostal artery injury during transthoracic puncture is rare but is accompanied by high rates of morbidity and mortality. We report a case with metachronous double primary esophageal cancers and development of multiple lung nodules. Tissue proof for the lung nodules is required to guide the following treatment protocol. Our patient died soon after computed tomography‐guided lung tumor biopsy was performed, as a result of procedure‐related massive and uncontrolled hemothorax. The cause is likely intercostal artery injury related to the transthoracic puncture. After review of our case and the wide variation in intercostal artery courses, we identify several considerations that should be included in procedural planning to further decrease the risk of intercostal artery injury during transthoracic puncture, including avoiding choosing target lesions at the posterior lung, keeping the puncture needle as close to the superior rib margin as possible, and checking the density of new pleural fluid. In addition, it is important to inform clinical doctors when the risk of periprocedural vascular injury is high.

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“…According to Liu et al [18] , discrimination between hemothorax and empyema was obtained with a cutoff value of 15.9 HU of the pleural fluid attenuation. However, it is not easy to distinguish chronic pleural empyema from spontaneous loculated hemothorax, because the incidence of the latter is much lower than that of pleural empyema and pyothorax-related hemothorax.…”

Section: Discussionmentioning

confidence: 99%

Primary pleural epithelioid angiosarcoma manifesting as a loculated hemothorax: A case report and literature review focusing on CT findings

Woo

Kim

et al. 2021

Radiology Case Reports

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Primary pleural angiosarcoma (PPA) is an extremely rare and clinically aggressive tumor. We report the case of a 66-year-old man having PPA with chest computed tomography (CT) scan showing a large oval-shaped, nonenhancing high attenuation cystic mass in the left hemithorax. Morphological and immunohistochemical findings supported the diagnosis of epithelioid angiosarcoma. Pleural angiosarcoma should be considered in the differential diagnosis of spontaneous hemothorax manifesting as high attenuation loculated pleural fluid on CT.

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Differentiate pleural effusion from hemothorax after blunt chest trauma; comparison of computed tomography attenuation values

Cited by 9 publications

References 21 publications

Diagnostic Accuracy of Imaging Findings in Pleural Empyema: Systematic Review and Meta-Analysis

Diagnostic Accuracy of Imaging Findings in Pleural Empyema: Systematic Review and Meta-Analysis

Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

Primary pleural epithelioid angiosarcoma manifesting as a loculated hemothorax: A case report and literature review focusing on CT findings

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