Abstract
The differential diagnosis of exudative pleural effusion is a major challenge for chest physicians particularly in a country with limited financial resources. The aim of this study was to evaluate the role of the sonographic features in the prediction of exudative malignant pleural effusion. This was a prospective cross-sectional study. This study was carried out between May 2013 and June 2014 in the Chest Department of Assiut University Hospital. The patients enrolled included 25 patients with malignant pleural effusion and 25 patients with other different benign causes. The sonographic appearances of pleural effusions were defined in terms of five patterns: anechoic, complex septated, complex nonseptated, pleural thickening, and pleural nodules. Among the 25 malignant exudative pleural effusions, a complex nonseptated pattern is a useful diagnostic predictor, with sensitivity, specificity, positive predictive value, and negative predictive value of 60, 68, 65, and 63%, respectively. Pleural nodules were only found in malignant effusion (100% specificity). If we define the complex septated sonographic pattern as a predictor for benign effusion, we can achieve sensitivity, specificity, positive predictive value, and negative predictive value of 52, 88, 81, and 65%, respectively. Pleural nodules and a complex nonseptated pattern in the sonographic appearance are useful predictors of malignant pleural effusions, whereas a complex septated pattern is a useful predictor in nonmalignant effusion.
Highlights
Pleural effusion is a highly common clinical presentation in malignant and benign diseases
The differential diagnosis of exudative pleural effusion is a major challenge for chest physicians in a country with limited financial resources
Pleural nodules were only found in malignant effusion (100% specificity)
Summary
Pleural effusion is a highly common clinical presentation in malignant and benign diseases. The differential diagnosis is broad and includes heart failure, parapneumonic effusion, empyema, pulmonary emboli, inflammatory disease, and malignancies. The differentiation between malignant and nonmalignant pleural effusions has often been made with cytologic examinations of pleural effusions, histologic examinations of pleural biopsies, helpful biomarkers, and even pleural biopsy [1,2,3]. With the advances in imaging technology and computerized functions, the chest sonographic examination has been used widely in the diagnosis and management of lung cancer, uncommon pulmonary consolidations, mediastinal tumors, and pleural diseases. Chest sonography is a very useful imaging tool for assessing the nature of pleural effusions [4]. The differential diagnosis of exudative pleural effusion is a major challenge for chest physicians in a country with limited financial resources
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