Quantification Of Pleural Effusion Research Articles

Ultrasound analysis of hemidiaphragm function in case of pleural effusion.

Diaphragm dysfunction is frequently observed in patients with pleural effusion. The aim of the study was to determine the criteria for estimating the impact of pleural fluid on diaphragm function and detecting impairment of diaphragmatic muscle. This was a retrospective observational study carried out in a university hospital. Cases of free pleural effusion were recruited from the ultrasound consultation of the lung function test laboratory. The quantification of pleural effusion and analysis of diaphragmatic function were performed using chest ultrasound performed while sitting. In case of abnormal diaphragmatic motion, the examination was repeated in supine position. 109 pleural effusions (57 left, 52 right) were included in the analysis. Pleural effusions were detected after thoracic surgery in 89% of cases and in the context of medical disease in other cases. Excursion during deep inspiration was reduced by the amount of fluid (4.3 ± 2.1 cm for small effusions, 3.2 ± 1.7 cm for moderate effusions and 1.1 ± 1.8 cm for large effusions). In 23 cases of large pleural effusion, the excursions during deep inspiration were always below the lower limit of normal. In some cases, a paradoxical motion suggesting hemidiaphragm paralysis was observed. When the inspiratory thickening was normal, the paradoxical excursions disappeared in supine position. In moderate pleural effusion (53 cases), hemidiaphragm excursion was above lower limit of normal in 68% of cases. In cases of paradoxical motions, repeated ultrasound examinations were in favor of hemidiaphragm paralysis. In small pleural effusion (32 cases) the excursion was most often normal. The ultrasound analysis of diaphragm excursion and thickening in sitting and supine positions is useful to assess the impact of pleural effusion and detect impairment in diaphragm muscle function.

Quantification of pleural effusions by two-dimensional transthoracic echocardiography.

There is lack of validated methods for quantifying the size of pleural effusion from standard transthoracic (TTE) windows. The purpose of this study is to determine whether pleural effusion (Peff) measured from routine two-dimensional (2D) TTE views correlate with chest radiograph (CXR). We retrospectively identified all inpatients who underwent a TTE and CXR within 2days in a large tertiary care center. Peff was measured on TTE from parasternal long axis (PLAX), apical four-chamber (A4C), and subcostal views and on CXR. Logistic regression models were used determine optimal cut points to predict moderate or greater Peff. In 200 patients (mean age 69.3 ± 14.3years, 49.5% female), we found statistically significant associations between Peff size assessed by all TTE views and CXR, with weak to moderate correlation (PLAX length: 0.21 (95% CI [0.05, 0.35]); PLAX depth: 0.21 (95% CI [0.05, 0.35]); A4C left: 0.31 (95% CI [0.13, 0.46]); A4C right: 0.39 (95% CI [0.17, 0.57]); subcostal: 0.38 (95% CI [0.07, 0.61]). The best TTE thresholds for predicting moderate or greater left-sided Peff on CXR was PLAX length left > = 8.6cm (sensitivity 78%, specificity 54%, PPV 26%, and NPV 92%). The best TTE thresholds for predicting moderate or greater right-sided Peff on CXR was A4C right > = 2.6cm (sensitivity 87%, specificity 60%, PPV 37%, and NPV 94%). We identified statistically significant associations with Peff size measured on TTE and CXR. The predictive ability of TTE to identify moderate or large pleural effusion is limited.

COMPARATIVE STUDY OF DIFFERENT FORMULAE OF ULTRASONOGRAPHIC QUANTIFICATION OF THE AMOUNT OF PLEURAL EFFUSION

Background: Pleural effusion may be a result of a primary pulmonary illness. It also can be the pleural manifestation of numerous of diseases that primarily affect other organs. Quantification of pleural effusion is of great value in clinical practice, as it usually guides the plan of management. Chest ultrasound (U/S) is one of the helpful non-invasive means in estimating pleural fluid volume. Objective: To correlate the U/S estimated volumes of pleural fluid calculated by studied formulae, with the actual effusion volume, and to identify the most accurate formula in quantifying the pleural fluid volume. Patients and Methods: This prospective cross-sectional study was carried out in the department of Chest, Bab Al-sha'reia University Hospital, during the period from October 2019 to September 2020, and included forty patients with clinical and radiological diagnosis of pleural effusion. Ultrasound estimation of the amount of pleural effusion was done using 4 different formulae, followed by full pleural drainage through either simple aspiration or tube thoracostomy. Lastly, the ultrasonographically estimated fluid volumes were then compared to the actually drained fluid volume. Results: The supine formulae showed excellent correlation with the drained pleural fluid volume, with Pearson correlation coefficient(r) = 0.9607 and 0.9602 for Eibenberger and Balik formulae respectively (p-value <0.0001). On the other side, the erect formulae were found to have reasonable correlations with the drained volume, with r= 0.4017 (p-value= 0.0102) and 0.5729 (p-value <0.0001) for Goecke1 and Goecke 2 respectively. All studied formulae failed to quantify the pleural effusion volume accurately when comparing its estimated volume to the actually drained fluid volume. Conclusion: The 4 studied formulae had good correlations with the actually drained volume. However, supine formulae were better than erect formulae.

Quantification of pleural effusions on thoracic ultrasound in acute heart failure.

Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically. In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size. Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score (P<0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography (P<0.001), higher NT-pro brain natriuretic peptide values (P=0.001) and a greater number of B-lines on lung ultrasound (P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92-1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11-5.37; P=0.027). Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.

QUANTIFICATION OF PLEURAL EFFUSION ON CT IMAGES BY AUTOMATIC AND MANUAL SEGMENTATION

The objective of this research is to make reliable estimation of pleural effusion volume in CT imaging using digital image processing algorithms. In order to make reliable estimation we need to do the manual and automatic segmentation of CT images and to perform the comparison of automatic and manual segmentation for the quantification of pleural effusion on CT images which provides help in the diagnosis of the pleural disease. Pleural effusion is the collection of excess fluid in the pleural cavity. Excessive amount of fluid can impair breathing by limiting the expansion of lungs. Heart failure, cancer, cirrhosis, pneumonia, tuberculosis and many other are the causes of pleural effusion. A number of noninvasive imaging techniques such as radiography, ultrasound and computed tomography (CT) can detect the pleural effusion. The problem faced is the quantification of pleural effusion volume for the purpose of diagnosis of the pleural disease. The objective of this research is to make reliable estimation of pleural effusion volume in CT imaging using digital image processing algorithm. In order to make reliable estimation we need to do the manual and automatic segmentation of CT images and to perform the comparison of automatic and manual segmentation for the quantification of pleural effusion on CT images which provides help in diagnosis of the pleural disease. The results obtained by both the aforementioned techniques indicate that the manual segmentation is better because automated technique has less number of pixels.

Feasibility and reliability of pocket-size ultrasound examinations of the pleural cavities and vena cava inferior performed by nurses in an outpatient heart failure clinic.

Routine assessment of volume state by ultrasound may improve follow-up of heart failure patients. We aimed to study the feasibility and reliability of focused pocket-size ultrasound examinations of the pleural cavities and the inferior vena cava performed by nurses to assess volume state at an outpatient heart failure clinic. Ultrasound examinations were performed in 62 included heart failure patients by specialized nurses with a pocket-size imaging device (PSID). Patients were then re-examined by a cardiologist with a high-end scanner for reference within 1 h. Specialized nurses were able to obtain and interpret images from both pleural cavities and the inferior vena cava and estimate the volume status in all patients. Time consumption for focused ultrasound examination was median 5 min. In total 26 patients had any kind of pleural effusion (in 39 pleural cavities) by reference. The sensitivity, specificity, positive and negative predictive values were high, all ≥ 92%. The correlations with reference were high for all measurements, all r ≥ 0.79. Coefficients of variation for end-expiratory dimension of inferior vena cava and quantification of pleural effusion were 10.8% and 12.7%, respectively. Specialized nurses were, after a dedicated training protocol, able to obtain reliable recordings of both pleural cavities and the inferior vena cava by PSID and interpret the images in a reliable way. Implementing focused ultrasound examinations to assess volume status by nurses in an outpatient heart failure clinic may improve diagnostics, and thus improve therapy.

Experience using of ultrasound guidance pleural tapping in pleural effusion after cardiac surgery in National Cardiac Centre Harapan Kita Hospital. Indonesia (Case Series)

Pleura effusion in post cardiac surgery is the one of problems in management of cardiac surgery patients. Large amounts of pleura effusion may affect the recovery period requiring a longer hospital stay. Early diagnosis and quantification of pleural effusion is important to be ideal postoperative adequate treatment. Ultrasound shows better sensitivity and reliability for diagnosis pleural effusion than physic diagnostic and X-ray. Ultrasound can be repeated serially at bedside without any radiation risk. Procedure perform under ultrasound guided showed a reduction of complication rate. We report 60 patients with pleural effusion after cardiac surgery. We perform tapping of fluid under guiding ultrasound. Before procedure we calculate amount of pleural effusion and make decision where site of needle will inserted. Regarding the literature we make intraclavicula line as a guided. Tapping procedure will perform if fluid more than 450 cc. Tapping procedure use abbocate needle no 14 or 16fr. Amount of perithoracosistesis fluid is almost same with fluid prediction of before +/- 50 cc, depend on body weight and size of heart if pleural effusion on left thorax. There are not complications after the procedure. Patient experiences were feel convenient and with minimal pain. After procedure patients can complete mobilization and if indication to discharge patients can discharge directly.

Quantification of pleural effusion from single area measurements on CT

The objective of this study was to determine if area measurements of pleural fluid on computed tomography (CT) reflect the actual pleural fluid volume (PEvol) as measured at autopsy, to establish a formula to estimate the volume of pleural effusion (PEest), and to test the accuracy and observer reliability of PEest.132 human cadavers, with pleural effusion were divided into phase 1 (n = 32) and phase 2 (n = 100). In phase 1, PEvol was compared to area measurements on axial (axA), sagittal (sagA), and coronal (corA) CT images. Linear regression analysis was used to create a formula to calculate PEest. In phase 2, intra-class correlation (ICC) was used to assess inter-reader reliability and determine the agreement between PEest and PEvol. PEvol correlated to a higher degree to axA (r s mean = 0.738; p < 0.001) than to sagA (r s mean = 0.679, p < 0.001) and corA (r s mean = 0.709; p < 0.001). PEest can be established with the following formula: axA × 0.1 = PEest. Mean difference between PEest and PEvol was less than 40 mL (ICC = 0.837-0.874; p < 0.001). Inter-reader reliability was higher between two experienced readers (ICC = 0.984-0.987; p < 0.001) than between an inexperienced reader and both experienced readers (ICC = 0.660-0.698; p < 0.001). Pleural effusions may be quantified in a rapid, reliable, and reasonably accurate fashion using single area measurements on CT.

Quantification of pleural effusion on CT by simple measurement

To find the simplest method for quantifying pleural effusion volume from CT scans. Seventy pleural effusions found on chest CT examination in 50 consecutive adult patients with the presence of free pleural effusion were included. The volume of pleural effusion was calculated from a three-dimensional reconstruction of CT scans. Planar measurements were made on CT scans and their two-dimensional reconstructions in the sagittal plane and at three levels on transversal scans. Individual planar measurements were statistically compared with the detected volume of pleural effusion. Regression equations, averaged absolute difference between observed and predicted values and determination coefficients were found for all measurements and their combinations. A tabular expression of the best single planar measurement was created. The most accurate correlation between the volume and a single planar measurement was found in the dimension measured perpendicular to the parietal pleura on transversal scan with the greatest depth of effusion. Conversion of this measurement to the appropriate volume is possible by regression equation: Volume = 0.365 × b(3) - 4.529 × b(2) + 159.723 × b - 88.377. We devised a simple method of conversion of a single planar measurement on CT scan to the volume of pleural effusion. The tabular expression of our equation can be easily and effectively used in routine practice.

A COMPARATIVE STUDY ON THE RADIOGRAPHIC AND SONOGRAPHIC PRESENTATION OF PLEURAL EFFUSION IN CHILDREN: TO ESTABLISH THE VALUE OF CHEST RADIOGRAPH WITH REGARDS TO THE RECOGNITION AND QUANTIFICATION OF PLEURAL EFFUSION AND TO ESTABLISH THE MINIMUM AMO

PURPOSE: To establish the value of chest radiograph with regards to the recognition and quantification of pleural effusion and to establish the minimum amount of fluid necessary to produce the radiographic signs of effusion in children.

Routine Echocardiographic Views Miss Significant Pleural Effusions

Objectives: To determine the benefit of adding chest scanning to the routine echocardiographic examination to diagnose pleural effusions. Background: Pleural effusions are common in several cardiac disorders, yet routine echocardiography is insensitive in delineating pleural fluid. Methods: Bilateral chest scanning was performed in addition to the routine echo examination in 100 consecutive inpatients referred for echocardiography with recent chest X rays (CXRs). Detection and quantification of pleural effusion by sonographic chest scanning was compared blindly with CXRs. Identification of pleural fluid was analyzed for correlation with clinical diagnosis of congestive heart failure (CHF) and elevated pulmonary artery pressures if found by echo‐Doppler examination. Results: Agreement on presence or absence of pleural effusion occurred in 88 of 100 patients—in 5 patients bilateral chest scanning detected pleural effusion with negative CXRs; in 7 patients CXRs suggested pleural effusion with negative bilateral chest scanning (all 7 patients had minor blunting of the costophrenic angle). Routine echo views only detected 22 of 51 patients (43%) with pleural effusion detected by bilateral chest scanning. In 45 patients with CHF, 29 (64%) had pleural effusion by bilateral chest scanning (25 bilateral, 1 left, 3 right) vs 12 (27%) by routine echo (only left pleural effusion seen). Ejection fraction and estimated pulmonary artery pressure did not differ between CHF patients with and without pleural effusion. Conclusions: Routine echocardiographic views underestimate the presence of pleural effusion in patients referred for study. Bilateral chest scanning is equal to CXRs for pleural effusion detection and provides clinically useful information which may be of particular benefit to patients with CHF.

Quantification of pleural effusions: sonography versus radiography.

To develop a practical method of estimating the volume of pleural effusions with sonography. Fifty-one patients underwent sonography of the pleural space while supine. Sonographic results and results of lateral decubitus radiography were compared with actual effusion volumes. The maximum thickness of the pleural fluid layer was measured with both modalities, while actual effusion volume was determined by means of complete drainage. Sonographic measurements correlated statistically significantly better with actual effusion volume (r = .80) than did radiographic measurements (r = .58) (P < or = .05). With sonographic measurement, an effusion width of 20 mm had a mean volume of 380 mL +/- 130 (standard deviation), while one of 40 mm had a mean volume of 1,000 mL +/- 330. Prediction error with sonographic measurement (mean, 224 mL) was statistically significantly less (P < or = .002) than that with radiographic measurement (mean, 465 mL). In quantification of pleural effusions, the sonographic measurement method presented is preferable to radiographic measurement.

Wertigkeit der Thoraxbettaufnahmen zur Diagnostik und Quantifizierung von Pleuraergüssen - Überprüfung mittels Sonographie

The purpose of this prospective study was to verify the value of the supine chest radiograph with regard to the recognition and quantification of pleural effusions. The findings of supine chest radiographs were compared to those of chest sonography in a total of 320 pleural cavities. The correct identification and quantification of a pleural effusion was possible by supine chest radiograph alone in only 55% of cases (176/320). In 20% (64/320) supine chest x-ray was falsely negative and in 15% (48/320) falsely positive. In 10% an existing effusion was in fact recognised on supine chest x-ray; however the amount of effusion was wrongly estimated.