Imaging of pleural disease

Abstract

The pleural space is a “potential” anatomical space which is formed of two layers: visceral and parietal. It normally contains a trace of fluid (∼10 mL in each hemithorax). Diseases of the pleura can manifest with thickening of the pleural membranes or by abnormal accumulation of air or liquid. Chest radiographs are often the first imaging tests to point to a pleural pathology. With the exception of pneumothorax, and due to the inherent limitations of chest radiographs, ultrasound and/or computed tomography are usually required to further characterise the pleural pathology and guide management. This review summarises the utility of different imaging tools in the management of pleural disease and discusses new and evolving tools in imaging of the pleura.

Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study

“…Fifth, we did not specifically analyze or compare the performance of US and CT in detecting septations and complex morphology within pleural effusions. Previous literature has suggested that lung US may have higher sensitivity than CT for revealing septated or loculated effusions, which can be an important indicator of malignancy [9]. By focusing primarily on evaluating pleural abnormalities, such as nodularity and thickening, we may have missed an opportunity to assess the complementary roles of these modalities in characterizing effusion complexity and internal architecture.…”

“…In recent years, noninvasive imaging modalities such as ultrasonography (US) and computed tomography (CT) have become increasingly important in evaluating pleural effusions and diagnosing MPE. These modalities can provide valuable information about the nature and characteristics of pleural effusion, potentially guiding clinical decision making and reducing the need for invasive procedures [7][8][9].…”

Infective Pleural Effusions—A Comprehensive Narrative Review Article

“…CT scans can detect effusions as small as 3–5 mL [ 28 ]. The thickening of the pleural membrane can reflect pleural disease, and other features that suggest pleural infections include oblong configuration, split pleural signs, hypertrophy, and the increased density of the extra-pleural fat [ 29 ]. When further comparing those modalities, pleural ultrasound had a sensitivity of 69.2% (95% confidence interval (CI) 48.2–85.7%) and a specificity of 90.0% (CI 76.3–97.2%).…”

“…MRI imaging usually reveals low signal on T1-weighted and high signal on T2-weighted in infectious effusions. It is superior to CT in detecting pleural fluid septation and extra-pleural fat changes [ 29 ]. Further cytological analysis, cell counts with differentials, pH, glucose, and microbial stains, and cultures are often obtained to aid in classifying effusions.…”