Role of transthoracic ultrasound in differentiation of the causes of pleural thickening

Abstract

Objectives Pleural thickening is defined as the increase in thickness of the pleura of more than 3mm and can be caused by a wide range of diseases, either nonmalignant or malignant. Thoracic ultrasound has high sensitivity in assessing the pleura. Aim The aim of this study was to assess the role of thoracic ultrasound in differentiation of the causes of pleural thickening. Design A prospective study included 48 patients selected from the inpatient Chest Department, Kasr Al-Ainy Hospital, from January 2016 till October 2017. Patients diagnosed as having pleural thickening underwent thoracic ultrasound as well as ultrasound-guided pleural biopsy by Tru-cut needle. Descriptive data were obtained including age and sex of the patients. Thoracic ultrasound was done for the side of pleural thickening. The distribution of pleural thickness, either localized or diffuse; the surface; invasion of chest wall or diaphragm; the echogenicity and vascularity; and the presence of pleural effusion and its pattern were determined. The patients were classified into two main groups: nonmalignant (subclassified as tuberculous and nonspecific infection) and malignant cases (subclassified as mesothelioma and metastatic cases). Results There was a statistically significant relation between the distribution either localized, diffuse, unilateral, or bilateral; the surface of the thickness; invasion of chest wall or diaphragm; the echogenicity; vascularity of the pleural thickness; and the presence of pleural effusion and its pattern on one hand and the diagnosis of pleural thickening on the other hand. There was insignificant statistical difference between pleural mesothelioma and pleural metastatic cases, and also there was insignificant statistical difference between tuberculous and nonspecific infection cases. Conclusion The transthoracic ultrasound had a very good predilection for the diagnosis of pleural thickening etiology whether malignant or nonmalignant.