Sonographic Appearances in Transudative Pleural Effusions: Not Always an Anechoic Pattern

Chen, Hung Jen; Tu, Chih Yen; Ling, Shinn Jye; Chen, Wei; Chiu, Kuo Liang; Hsia, Te Chun; Shih, Chuen Ming; Hsu, Wu Huei

doi:10.1016/j.ultrasmedbio.2007.09.009

Cited by 51 publications

(44 citation statements)

References 8 publications

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“…Visualization of internal echoes, either of mobile particles or septa, is highly suggestive of exudate or hemothorax [72][73][74][75][76]. However, when faced with an anechoic effusion, the only way to differentiate between transudate and exudate is to use thoracentesis or alternatively to evaluate effusion in the clinical context [71,[77][78][79].…”

Section: Rl-d4-s2 (Strong: Level B)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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Background: The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. Methods: A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Results: Seventythree proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/ conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. Conclusions: This document reflects the overall results of the first consensus conference on ''point-of-care'' lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.

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Section: Rl-d4-s2 (Strong: Level B)mentioning

confidence: 99%

International evidence-based recommendations for point-of-care lung ultrasound

et al. 2012

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“…20 Although transudative pleural effusions are typically anechoic, as many as 55% of proven transudative pleural effusions will have a complex nonseptated appearance. 21 Conversely, although most complicated parapneumonic effusions and empyemas contain internal echoes or appear entirely echogenic, up to 27% of exudative effusions are anechoic. 20 Uniformly echogenic collections typically contain blood or debris and almost invariably indicate the presence of an empyema in patients who appear clinically infected.…”

Section: Chest Ultrasonographymentioning

confidence: 99%

Diagnostic Utility and Clinical Application of Imaging for Pleural Space Infections

Heffner

Klein

Hampson

2010

Chest

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“…A retrospective study of 140 patients found an echogenic swirling pattern on ultrasound in a number of patients with transudates (liver cirrhosis, nephrotic syndrome, and congestive heart failure), and an echogenic swirling pattern did not correlate with pleural fluid biochemical parameters including protein or LDH [4]. A retrospective study of 127 patients with transudative pleural effusions, published in 2008, found that 55% were associated with an echogenic pattern with no septations [5]. …”

Section: Discussionmentioning

confidence: 99%

Prospective Analysis of the Predictive Value of Sonographic Pleural Fluid Echogenicity for the Diagnosis of Exudative Effusion

et al. 2019

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Background: Pleural effusion echogenicity on ultrasound has previously been suggested to allow identification of exudates. A case series suggested that homogenously echogenic effusions are always exudates. With modern imaging techniques and more advanced ultrasound technology, this may no longer be true. Objectives: This study aims to prospectively assess the predictive value of echogenicity in the identification of exudates. Method: Patients undergoing thoracic ultrasound before pleural fluid sampling were analysed prospectively (n = 140). Pleural fluid was classified as an exudate if both fluid total protein (TP) > 29 g/L and fluid lactate dehydrogenase (LDH) > 2/3 upper limit of normal serum LDH (which is 255 IU/L in females and 235 IU/L in males) were present. If only one of these criteria was met, the effusion was considered to have discordant biochemistry. Results: Fifty-five (39%) patients had non-echogenic and 85 (61%) had echogenic effusions. Six (7.1%) patients with echogenic effusions had transudates; the median fluid TP for this group was 18.5 g/L (IQR 9.75) and median LDH 63.0 IU/L (IQR 40.3). The specificity of echogenicity identifying exudates from transudates, excluding patients with discordant biochemistry, was 57.1%, positive predictive value (PPV) 90.3%, sensitivity 65.1%, and negative predictive value (NPV) 21.0%. The specificity of echogenicity identifying exudates (including discordant biochemistry) from transudates was 57.1%, PPV 92.9%, sensitivity 62.7%, and NPV 14.5%. Conclusions: Echogenicity of a pleural effusion has a low specificity for identifying an underlying exudate, and the echogenic qualities of the fluid should not influence clinical decision-making.

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Sonographic Appearances in Transudative Pleural Effusions: Not Always an Anechoic Pattern

Cited by 51 publications

References 8 publications

International evidence-based recommendations for point-of-care lung ultrasound

International evidence-based recommendations for point-of-care lung ultrasound

Diagnostic Utility and Clinical Application of Imaging for Pleural Space Infections

Prospective Analysis of the Predictive Value of Sonographic Pleural Fluid Echogenicity for the Diagnosis of Exudative Effusion

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