Lung ultrasound in the evaluation of pleural effusion

Prina, Elena; Torres, Antoni; Carvalho, Carlos Roberto Ribeiro

doi:10.1590/s1806-37132014000100001

Cited by 32 publications

(32 citation statements)

References 16 publications

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“…A wedge-shaped hypoechoic lesion with an air bronchogram in the lung parenchyma suggests a consolidation. 7 In general, the complex presentations are more likely to suggest an exudative effusion. Of note, a new effusion as a result of a hemothorax should not have a complex presentation.…”

Section: Ultrasound Findings-pleural Effusionmentioning

confidence: 99%

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Haskins

Tsui

Nejim

et al. 2017

Regional Anesthesia and Pain Medicine

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In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and pain specialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions.

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Section: Ultrasound Findings-pleural Effusionmentioning

confidence: 99%

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Haskins

Tsui

Nejim

et al. 2017

Regional Anesthesia and Pain Medicine

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show abstract

“…however, massive effusion without contralateral mediastinal shift, malignant mesothelioma is more likely. 4 Bilateral effusions are most commonly transudates, as seen with congestive heart failure, nephrotic syndrome, hypoalbuminemia, and constrictive pericarditis. Bilateral pleural effusions with no cardiomegaly is most likely related to malignancy, or may occur in hepatic hydrothorax and hypoalbuminemia.…”

Section: Most Of Unilateral Effusions Are Exudativementioning

confidence: 99%

“…(Box 3) 9,10 However, ultrasound also has certain limitations as soft tissue edema, subcutaneous emphysema, or obesity can reduce quality of images and make it difficult to interpret. 4 CT-SCAN AND OTHER IMAGING TECHNIQUES: Chest CT scan with contrast is needed in an undiagnosed pleural effusion to detect thickened pleura or signs of invasion of underlying/ adjacent structures, in imperative pulmonary embolism or tuberculous pleuritis. CT angiography is mandatory if pulmonary embolism is suspected.…”

Section: Most Of Unilateral Effusions Are Exudativementioning

confidence: 99%

Evaluation of Pleural Effusion

Y¹,

Parimala²

2015

jebmh

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INTRODUCTION: Normal pleural space between visceral and parietal pleura is lined by thin film of fluid, but excess fluid accumulation in pleural space under certain pathological condition is termed pleural effusion. 1 Pleural effusions is common occurrence in both medical and surgical patients. The prevalence of pleural effusion is estimated to be slightly in excess of 400/100000 population. 2 Pleural effusion is an indicator of an underlying disease process that may be pulmonary or non-pulmonary in origin and may be acute or chronic. The most common types of fluid in pleural effusion include transudates and exudates, though there can be blood or pus also in pleural effusion. However, mechanisms leading to pleural effusion are different. (Box 1) These may differ in different etiologies, and include: increased hydrostatic pulmonary pressure in heart failure, increased capillary permeability in pneumonia, decreased oncotic pressure in hypoalbuminemia, decreased intrapleural pressure in atelectasis, obstructed lymph flow and increased pleural membrane permeability in pleural malignancy/infection, and diaphragmatic defects in hepatic hydrothorax. Rupture of thoracic duct is involved in chylothorax. 3 DIAGNOSIS OF PLEURAL EFFUSION: Patients with pleural effusions should be studied systematically. Detailed history taking and physical examination can help to establish direction towards diagnosis even before any other investigations. Based on history and examination, with signs/symptoms indicating a suspected pleural effusion, the initial step in evaluation of such patients is to confirm the diagnosis with radioimaging techniques (Chest X ray, ultrasound, computed tomography (CT) scan, etc). Next, the distinction between transudative and exudative pleural effusions would give an idea about the nature of fluid and narrow down the diagnosis. However, in many cases, a definitive diagnosis may require thoracentesis which allows withdrawing the pleural fluid sample and undertaking its physical, chemical, and microbiological studies. 4

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“…Several imaging methods such as conventional radiography, ultrasonography (USG), computerized tomography (CT) scan and magnetic resonance imaging (MRI) are being used to diagnose and assess the etiology of pleural effusion [6]. Ultrasonography is the most commonly used modality with higher accuracy in detecting pleural effusion in comparison with chest X-rays (93% vs. 47%) [7,8]. It has a much higher sensitivity than conventional radiology in the diagnosis of small amounts of effusion, nature of effusion [9] and differentiation of the loculated pleural fluid and the thickened pleura [5,7,10,11].…”

Section: Introductionmentioning

confidence: 99%

“…Ultrasonography is the most commonly used modality with higher accuracy in detecting pleural effusion in comparison with chest X-rays (93% vs. 47%) [7,8]. It has a much higher sensitivity than conventional radiology in the diagnosis of small amounts of effusion, nature of effusion [9] and differentiation of the loculated pleural fluid and the thickened pleura [5,7,10,11]. CT is frequently used to assess patients with pleural abnormalities associated with neoplasm, pneumonia, and empyema.…”

Section: Introductionmentioning

confidence: 99%

Efficacy Of ultrasonography and computed tomography in differentiating transudate from exudate in patients with pleural effusion

Bandaru¹,

Rachegowda²

2018

Imaging-Medicine

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To evaluate USG and CT imaging findings in differentiating transudative and exudative pleural effusion. Materials and methods: A prospective observational study was performed over a period of eighteen months between January 2016 and June 2017. Eighty patients with pleural effusion were included and were evaluated with USG and CT along with diagnostic thoracocentesis. USG appearances and CT attenuation values along with additional findings like presence of pleural thickening, pleural nodules and loculation were evaluated. Results: 24 (30%) were transudates and 56 (70%) were exudates. Transudative were always anechoic. Exudates were complex septated (62.5%), echogenic (25%) or complex non-septated (8.9%) on USG with very few being anechoic (3.5%). Loculations were better appreciated on ultrasound while pleural thickening and nodules were better seen on CT. Mean attenuation values were significantly higher in exudates (14.65 ± 6.07; mean ± SD, range: 4.5 to 34) than transudates (4.66 ± 2.29; mean ± SD, range: 1.3 to 8.2) with a P value <0.01. Effusions can be considered as transudative if the CT attenuation value is <8, with a sensitivity of 91.6% and specificity of 82.7% with a significant P value <0.01. Pleural thickening, nodules and loculations were seen commonly in exudates than transudates with a high specificity (91.6 %, 95.8% and 100% respectively). Conclusion: USG is a helpful non-invasive and bedside tool in determining the nature of pleural effusion. CT attenuation values play a useful role in differentiating the nature of pleural effusion. Transudative effusions can be considered when HU values are <8.

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Lung ultrasound in the evaluation of pleural effusion

Cited by 32 publications

References 16 publications

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Evaluation of Pleural Effusion

Efficacy Of ultrasonography and computed tomography in differentiating transudate from exudate in patients with pleural effusion

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