Abstract
Objectives: Pleural effusion is a common reason for hospital admission with thoracentesis often required to diagnose an underlying cause. This study aimed to determine if the imaging characteristics of TUS effectively differentiates between transudative and exudative pleural fluid. Methods: Patients undergoing TUS with pleural fluid analysis were retrospectively identified at a single center between July 2016 and March 2018. TUS images were interpreted and characterized by established criteria. We determined diagnostic performance characteristics of image criteria to distinguish transudative from exudative pleural effusions. Results: 166 patients underwent thoracentesis for fluid analysis of which 48% had a known malignancy. 74% of the pleural effusions were characterized as exudative by Light's Criteria. TUS demonstrated anechoic effusions in 118 (71%) of samples. The presences of septations on TUS was highly specific in for exudative effusions (95.2%) with high positive predictive values (89.5%) and likelihood ratio (2.85). No TUS characteristics, even when adjusting for patient characteristics such as heart failure or malignancy, were sensitive for exudative effusions. Conclusions: Among our cohort, anechoic images did not allow reliable differentiation between transudative and exudative fluid. Presence of complex septated or complex homogenous appearance was high specific and predictive of exudative fluid.
Highlights
Over 1.5 million people develop pleural effusion each year and there is an estimated prevalence of 60% in the intensive care unit (ICU) [1,2]
Most prior studies have shown that Thoracic ultrasound (TUS) was reliable in identifying exudative effusions but not transudative effusion; outside of a recent evaluation by Shkolnik and Asciak et al, these studies were older with different technology, and often had smaller sample sizes [6,7,8,9]
We examined the diagnostic performance of TUS in predicting transudative and exudative effusions
Summary
Over 1.5 million people develop pleural effusion each year and there is an estimated prevalence of 60% in the intensive care unit (ICU) [1,2]. The use of TUS to guide thoracentesis has improved procedural safety and should be considered standard of care, there are still risks associated with the procedure [4,5]. The ability to predict the chemical characteristics of a pleural effusion prior to sampling may impact subsequent management and potentially decrease the need for thoracentesis and associated procedural risks. There have been limited data that have examined the diagnostic accuracy of TUS’s ability to differentiate a transudative from an exudative effusion. Most prior studies have shown that TUS was reliable in identifying exudative effusions but not transudative effusion; outside of a recent evaluation by Shkolnik and Asciak et al, these studies were older with different technology, and often had smaller sample sizes [6,7,8,9]
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