Sonographic evaluation of unexplained pleural exudate: a prospective case series
- 87 Downloads
BACKGROUND: Thoracic ultrasound may be helpful in differentiating between malignant and tuberculosis-associated pleural exudate. This study aimed to evaluate its utility in patients with unexplained pleural exudate. METHODS: Consecutive patients were screened and pleural effusion was found in 278 patients. Pleural exudate was present in 106 patients and remained undiagnosed after biochemical and cytological evaluation in 40 patients (median age 58 years, 67% men) who then underwent detailed thoracic ultrasound for the presence of complex (septated or fibrous) or anechoic patterns. Pleural needle biopsy or thoracoscopy with histological evaluation were used for definitive diagnosis. RESULTS: History, clinical characteristics and routine procedures including cytology were not helpful in differential diagnosis. Pleural specimens for histological evaluation were obtained from all 40 patients and confirmed tuberculosis in 12 patients, cancer in nine and nonspecific pleuritis in 19. Sonographic finding of a complex septal pattern was present only in patients with tuberculosis (positive predictive value 100%); anechoic appearance was suggestive of nonspecific pleuritis (positive predictive value 65%). CONCLUSIONS: Thoracic ultrasound is a useful bedside method for differentiation of the etiology of pleural exudate. When a complex septal pattern is found, pleural needle biopsy should be the next diagnostic procedure, whereas with less complex pleural sonography findings other methods should be pursued.
KeywordsThoracic ultrasound Tuberculosis Malignancy Pleural effusion
Unable to display preview. Download preview PDF.
- Hung-Jen Chen, Wu-Huei Hsu, Chin-Yen Tu, Yang-Hao Yu, Kuo-Liang Chiu, Liang-Wen Hang, et al (2006) Sonographic septation in lymphocyte-rich exudative pleural effusions. J Ultrasound Med 25: 857–863Google Scholar
- Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH (1992) Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. Am J Roentgenol 159: 29–33Google Scholar