ES07.01 Radiological Evaluation of Pleural Effusion in a Cancer Patient

Abstract

Pleural effusion (PE) is not infrequently seen in cancer patients. Malignant pleural effusion (MPE) is an exudative effusion with malignant cells. MPE is a common symptom and accompanying manifestation of metastatic disease. It affects up to 15% of all patients with cancer and is the most common in lung, breast cancer, and gastrointestinal tract adenocarcinoma or ovarian, gynecological malignancies and malignant mesothelioma. Once PE is identified in a cancer patient, the most important issue is to clarify the nature of pleural effusion which is benign or malignant. The most common radiographic evaluation of cancer patients is chest radiograph. Radiographical detection of small PE is difficult on chest PA view unless significant amount to obscured the lateral costophrenic angles. Computed tomography (CT) is commonly used for clinical staging which may reveal the presence of pleural effusion, thickening, nodularity or mass(es). The presence of pleural nodularity or masses in a cancer patient is frequently due to pleural metastasis or tumor seeding. Pleural effusion in patients with lung cancer may raise high suspicion of malignant pleural effusion (M1a) unless there is associated pneumonia or heart failure which may be the etiology of pleural effusion. Clinical workup of the persistent PE in a cancer patient should be carried out even nonvisualization of pleural nodularity or tumor seeding. Microscopic evidence or analysis of the cell block from PE is important to diagnose the etiology of pleural effusion. In this refreshed lecture, we are going to show typical MPE and suggested algorithm if PE is found in a cancer patient. pleural effusion, Radiology