Abstract
Computed tomography (CT) diagnosis of empyema is challenging because current literature features multiple overlapping pleural findings. We aimed to identify informative findings for structured reporting. The screening according to inclusion criteria (P: Pleural empyema, I: CT C: culture/gram-stain/pathology/pus, O: Diagnostic accuracy measures), data extraction, and risk of bias assessment of studies published between 01-1980 and 10-2021 on Pubmed, Embase, and Web of Science (WOS) were performed independently by two reviewers. CT findings with pooled diagnostic odds ratios (DOR) with 95% confidence intervals, not including 1, were considered as informative. Summary estimates of diagnostic accuracy for CT findings were calculated by using a bivariate random-effects model and heterogeneity sources were evaluated. Ten studies with a total of 252 patients with and 846 without empyema were included. From 119 overlapping descriptors, five informative CT findings were identified: Pleural enhancement, thickening, loculation, fat thickening, and fat stranding with an AUC of 0.80 (hierarchical summary receiver operating characteristic, HSROC). Potential sources of heterogeneity were different thresholds, empyema prevalence, and study year.
Highlights
Pleural effusion is common with an incidence of 0.32% per year in the general population [1] amounting to approximately 1.5 million people in the United States each year alone [2]
Pleural effusion is related to pneumonia, malignancy, or trauma, which may become secondarily infected
Empyema accounts for only 5–10% of parapneumonic effusions [5,6], it is associated with worse outcomes: Longer hospital stays and more complications, especially in culture-positive empyemas [7]
Summary
Pleural effusion is common with an incidence of 0.32% per year in the general population [1] amounting to approximately 1.5 million people in the United States each year alone [2]. Pleural effusion is related to pneumonia, malignancy, or trauma, which may become secondarily infected. Empyema accounts for only 5–10% of parapneumonic effusions [5,6], it is associated with worse outcomes: Longer hospital stays and more complications, especially in culture-positive empyemas [7]. Computed tomography (CT) is a valuable imaging modality for diagnosing pleural effusions and identifying their etiology [9]. It is an integral part of diagnostic procedures for a timely diagnosis of empyema
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