Pleural ultrasonography, new standard for para pneumonic effusion? French multicentric prospective study. Preliminary report

Abstract

Introduction: Parapneumonic pleuritis are frequently associated with high morbidity and severe sequelae. Management of this complication include early pleural evacuation. Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pleural effusion. Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is evaluate pleural sequelae with early use of LUS in detection Methods: In this multicentric prospective study, a consecutive sample of suspected patients with CAP was underwent daily LUS. Each patient received a chest x-ray and ultrasound on admission every day. The analysis of the pleural fluid was left to the discretion of the physician . The patients were monitored only 4 days if they had no para pneumonic pleurisy and benefited from an appropriate management if not. Complete respiratory explorations were carried out at 3 and 6 months. Results: In this preliminary reports , 65 patients with CAP were enroled : 48,3% females , mean age 64,4 years Sensitivity of LUS and CXR in detection of parapneumonic effusion were 91% and 40% respectively. Specificity of CXR was 40% while the LUS specificity was 92%. The evolution of pleurisy was unpredictable over the observation period with a significant diagnostic delay of the CXR. No pleurisy occurred after the 4-day period, the failure was 4.6% Compared with nearly 20% of the literature. Conclusion: Findings of the present study demonstrated high incidence of parapneumonic effusion and the higher diagnostic accuracy of LUS versus CXR. A daily echography is necessary and sufficient to detect the effusion and take care of it.