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Quantification of pleural effusions by two-dimensional transthoracic echocardiography

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Abstract

Purpose

There is lack of validated methods for quantifying the size of pleural effusion from standard transthoracic (TTE) windows. The purpose of this study is to determine whether pleural effusion (Peff) measured from routine two-dimensional (2D) TTE views correlate with chest radiograph (CXR).

Materials and methods

We retrospectively identified all inpatients who underwent a TTE and CXR within 2 days in a large tertiary care center. Peff was measured on TTE from parasternal long axis (PLAX), apical four-chamber (A4C), and subcostal views and on CXR. Logistic regression models were used determine optimal cut points to predict moderate or greater Peff.

Results

In 200 patients (mean age 69.3 ± 14.3 years, 49.5% female), we found statistically significant associations between Peff size assessed by all TTE views and CXR, with weak to moderate correlation (PLAX length: 0.21 (95% CI [0.05, 0.35]); PLAX depth: 0.21 (95% CI [0.05, 0.35]); A4C left: 0.31 (95% CI [0.13, 0.46]); A4C right: 0.39 (95% CI [0.17, 0.57]); subcostal: 0.38 (95% CI [0.07, 0.61]). The best TTE thresholds for predicting moderate or greater left-sided Peff on CXR was PLAX length left >  = 8.6 cm (sensitivity 78%, specificity 54%, PPV 26%, and NPV 92%). The best TTE thresholds for predicting moderate or greater right-sided Peff on CXR was A4C right >  = 2.6 cm (sensitivity 87%, specificity 60%, PPV 37%, and NPV 94%).

Conclusions

We identified statistically significant associations with Peff size measured on TTE and CXR. The predictive ability of TTE to identify moderate or large pleural effusion is limited.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiology, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, V5Z 1M9, Canada

    Jeffrey Yim, Soohyun A. Chang, Darwin F. Yeung, Ken Gin, John Jue, Parvathy Nair, Michael Y. C. Tsang, Christina Luong & Teresa S. M. Tsang

  2. Arthritis Research Canada, Richmond, BC, Canada

    Eric C. Sayre

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  1. Jeffrey Yim
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Correspondence to Soohyun A. Chang.

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Soohyun A. Chang, Jeffrey Yim, Darwin F. Yeung, Eric C. Sayre, Ken Gin, John Jue, Parvathy Nair, Michael Y.C. Tsang, Christina Luong, and Teresa S.M. Tsang declare no conflict of interest.

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Yim, J., Chang, S.A., Yeung, D.F. et al. Quantification of pleural effusions by two-dimensional transthoracic echocardiography. J Echocardiogr 21, 33–39 (2023). https://doi.org/10.1007/s12574-022-00586-5

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  • DOI: https://doi.org/10.1007/s12574-022-00586-5

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