The Assessment of Pleural Effusion Using CT Pulmonary Angiography-A Review

Abstract

Background: Pleural effusion is a common clinical presentation with various etiologies, including pulmonary embolism (PE), which remains underdiagnosed. The association between PE and pleural effusion, particularly the exudative type, necessitates a thorough understanding of the diagnostic role of computed tomography pulmonary angiography (CTPA). Objective: This review aims to elucidate the prevalence and characteristics of pleural effusions in PE patients and to evaluate the effectiveness of CTPA in the diagnosis of unilateral pleural effusions of unknown etiology. Methods: A systematic search across databases such as Google Scholar, PubMed, and NCBI yielded 39 articles, from which 20 met the inclusion criteria focused on the diagnostic utility of CTPA for unilateral pleural effusion. Studies were appraised for relevance to PE and pleural effusion, methodological rigor, and contribution to the field. Results: The review revealed that pleural effusions associated with PE typically present modestly and peak around the third day post-embolism. Persistent or late-onset effusions may suggest recurrent embolism or other pathologies. Contrast-enhanced CT demonstrated variable sensitivity and specificity in detecting malignant pleural effusions, suggesting the need for cautious interpretation and possible further invasive investigation. Conclusion: CTPA plays a critical role in the evaluation of pleural effusion, especially when PE is suspected. An integrated diagnostic approach, including pleural-phase thoracic CT, is recommended for patients with suspected malignant pleural effusions to improve clinical outcomes.