Clarification on Pleural Effusions in COVID-19.

Abstract

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 3 Previous Letters to the EditorFree AccessClarification on Pleural Effusions in COVID-19Avinash Aujayeb Avinash Aujayeb Author AffiliationsDepartment of Respiratory and Acute Medicine, Northumbria Healthcare NHS Foundation Trust, Northumbria Way, Cramlington NE23 6NZ, Englande-mail: [email protected]Avinash Aujayeb Published Online:Jun 11 2020https://doi.org/10.1148/ryct.2020200330MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In Editor:We thank Dr Tabatabaei and colleagues for their recent article in the April 2020 issue of Radiology: Cardiothoracic Imaging on CT characteristics of 120 patients with coronavirus disease 2019 (COVID-19) with a wide range of clinical outcomes (1). A total of 12.5% (19 of 96) of ward patients, 45% (nine of 11) of those in intensive care, and 23% (three of 13) of those deceased had pleural effusions. The authors rightly mention that the incidence of pleural effusions is out of keeping with other published studies and that pleural effusions are uncommon in COVID-19 (2). Therefore, we must dispute this finding in the absence of further explanations. It would be important to know if the effusions were unilateral or bilateral, whether those patients had any coexisting comorbidities such as concurrent heart, renal, or liver failure, or any disseminated malignancies which are by far the most common cause of pleural effusions, and more importantly whether any of those effusions were sampled and what were the resultant biochemical and microbiologic characteristics. So far, in the literature, there is only one report of pleural effusions in deceased COVID-19 patients being positive for the virus (3). However, patient characteristics in that study are also not described. We run a large pleural service in the North East of England, and this would greatly inform local and national practice (4). Current British Thoracic Society guidance suggests that all pleural procedures are potentially aerosol generating and could spread the virus, but the statement mentions that the evidence is poor (5). We believe the case series will be greatly enhanced if the details above are provided. If they cannot be provided, perhaps a note of caution should be added to the article by way of reply to this letter? We would also welcome any chance of international collaboration on the matter.Disclosures of Conflicts of Interest: A.A. disclosed no relevant relationships.