Front-door Thoracic Ultrasound in Patients with Community-Acquired Pneumonia to Diagnose and Predict Pleural Infection – A Prospective Study

Abstract

Pneumonia remains a significant public health concern, affecting a substantial portion of the UK adult population annually. This study investigated the utility of front-door thoracic ultrasound (TUS) in the early identification of parapneumonic effusion (PPE) and its subsequent progression to pleural infection in patients with community-acquired pneumonia (CAP). Forty-one CAP patients were enrolled at a District General Hospital in the UK, and TUS was utilized within 24 h of admission. The study revealed a higher incidence of PPE (63%) than previously reported. Forty-six percent of patients with PPE had effusions detected solely by TUS, which were not visible on chest X-rays (CXR). Additionally, all patients who died during admission had TUS-detected effusions, with three of them not showing effusion on the corresponding CXR. However, there were no specific TUS features that correlated with pleural infection development or resolution. The study also indicated higher mortality in patients with pleural effusion, although statistical significance was not reached due to the sample size.This pilot study underscores the potential of TUS in identifying previously undetected PPE in CAP patients. However, further research is needed to evaluate the role of TUS in pneumonia management to better understand the natural history of PPEs and their implications for patient outcomes.