Transthoracic Ultrasonography Research Articles

Transthoracic Ultrasound Improves Cardiac Function in Mice.

Cardiac dysfunction is a severe complication that is associated with an increased risk of mortality in multiple diseases. Cardioprotection solution that has been researched is the electrical stimulation of the vagus nerve to exert cardio protection. This method has been shown to reduce the systemic inflammatory response and maintain the immune homeostasis of the heart. However, the invasive procedure of electrode implantation poses a risk of nerve or fiber damage. Here, we propose transthoracic ultrasound stimulation (US) of the vagus nerve to alleviate cardiac dysfunction caused by lipopolysaccharide (LPS). We developed a noninvasive transthoracic US system and exposed anesthetized mice to ultrasound protocol or sham stimulation 24 h after LPS treatment. Results showed that daily heart targeting US for 4 days significantly increased left ventricular systolic function ( p = 0.01) and improved ejection fraction ( p = 0.03) and shortening fraction ( p = 0.04). Furthermore, US significantly reduced inflammation cytokines, including IL-6 ( p = 0.03) and IL- 1β ( p = 0.04). In addition, cervical vagotomy abrogated the effect of US, suggesting the involvement of the vagus nerve's anti-inflammatory effect. Finally, the same ultrasound treatment but for a longer period (14 days) also significantly increased cardiac function in naturally aged mice. Collectively, these findings suggest the potential of transthoracic US as a possible novel noninvasive approach in the context of cardiac dysfunction with reduced systolic function and provide new targets for rehabilitation of peripheral organ function.

Transthoracic ultrasonography in the assessment of interstitial lung disease in patients with systemic sclerosis

Background: Transthoracic ultrasonography was considered, sometimes in the past as unsuitable for the assessment of lung but it eventually emerged as an important tool in the diagnosis and in guiding treatment of various lung and pleural diseases. Several studies in the past proved it to be a useful complementary tool in the detection of interstitial pulmonary fibrosis. Aims and Objectives: This study aims to assess the utility of transthoracic uultrasonography (TUS) in comparison to high-resolution computed tomography (HRCT) thorax in the detection of interstitial lung disease (ILD) in systemic sclerosis (SSc) patients. Materials and Methods: SSc patients with HRCT proven ILD were identified and classified according to Warrick’s score. Sonographic evidence of ILD in these patients were judged by the presence of B-lines or ultrasonic lung comets (ULCs). Each procedure was studied and interpreted by two independent examiners blinded about the patient’s clinical and radiological features. Standard spirometric measurements were performed in all patients. Results: A highly significant positive linear correlation between ULCs and Warrick’s score was found in this study (r=0.83, P≤0.001). ULC score had moderate negative correlation with forced expiratory volume in 1 s (FEV1) % p (r=−0.60, P=0.001) and weak negative correlation with forced vital capacity (FVC) % p (r=−0.45, P=0.01) and FEV1/FVC % (r=−0.42, P=0.02). Conclusion: USG lung can be suggested as a useful non-invasive tool in the detection of ILDs in scleroderma patients.

Investigation of Childhood Pneumonia With Thoracic Ultrasound: A Comparison Between X-ray and Ultrasound.

Childhood pneumonia is a common entity, and chest x-rays are widely used as an initial diagnostic step. To avoid radiation exposure in the pediatric age group, we assessed whether the diagnostic accuracy of ultrasound (US) imaging is sufficient in the diagnosis. One hundred thirty-three children with pneumonia (72 girls/61 boys) were participated to study between 2019 and 2021. All participants had a chest x-ray. Radiologists who perform the US scans and interpret the x-rays were blinded to each other. A comparative analysis was also done to assess US findings on pneumonia for different age groups. We compare the diagnostic accuracy of US and x-rays by McNemar test and receiver operating characteristic curves. Intraclass correlation coefficient values were calculated for the assessment of interobserver agreement of x-ray evaluation. The participants' ages ranged from 1 month to 17 years and 8 months with a median age of 24 months (Q 1 : 8 and Q 3 : 66 months). Hospital stay lengths were longer, consolidation depths were greater, and presence of air bronchogram or pleural effusion was more frequent in school-age children. The proportion of consolidation seen on chest x-ray and transthoracic US scan was significantly different ( P < 0.001). The area under the curve was greater in the US than in the chest x-ray (area under the curve, 0.94 and 0.76 respectively). There was a good agreement between the 2 interpreters on chest x-ray assessment ( κ = 0.661). The thoracic US can be used as a safe and efficient imaging tool in the diagnosis of pediatric pneumonia.

Clinical Utility of Chest Sonography in Chronic Obstructive Pulmonary Disease Patients Focusing on Diaphragmatic Measurements.

There are many methods of evaluating diaphragmatic function, including trans-diaphragmatic pressure measurements, which are considered the key rule of diagnosis. We studied the clinical usefulness of chest ultrasonography in evaluating stable chronic obstructive pulmonary disease (COPD) patients and those in exacerbation, focusing on diaphragmatic measurements and their correlation with spirometry and other clinical parameters. In a prospective case-control study, we enrolled 100 COPD patients divided into 40 stable COPD patients and 60 patients with exacerbation. The analysis included 20 age-matched controls. In addition to the clinical assessment of the study population, radiological evaluation included chest radiographs and chest computed tomography. Transthoracic ultrasonography (TUS) was performed for all included subjects. Multiple A lines (more than 3) were more frequent in COPD exacerbation than in stable patients, as was the case for B-lines. TUS significantly showed high specificity, negative predictive value, positive predictive value, and accuracy in detecting pleural effusion, consolidation, pneumothorax, and lung mass. Diaphragmatic measurements were significantly lower among stable COPD subjects than healthy controls. Diaphragmatic thickness and excursion displayed a significant negative correlation with body mass index and the dyspnea scale, and a positive correlation with spirometry measures. Patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D showed lower diaphragmatic measurements (thickness and excursion). The TUS of COPD patients both in stable and exacerbated conditions and the assessment of diaphragm excursion and thickness by TUS in COPD patients and their correlations to disease-related factors proved informative and paved the way for the better management of COPD patients.

The Value of Left Internal Mammary Artery Flow Velocity in Predicting the Prognosis of Patients After Coronary Artery Bypass Grafting.

The purpose of this study was to explore the value of the left internal mammary artery flow velocity (LIMAV) measured by ultrasound before coronary artery bypass grafting (CABG) in predicting the prognosis of patients after left internal mammary artery (LIMA) bypass grafting. One hundred and four patients who underwent CABG with LIMA as the bridge vessel in the cardiovascular surgery department of our hospital between May 2018 and June 2019 were selected. All patients underwent transthoracic Doppler ultrasonography to measure LIMAV preoperatively. Intraoperatively, mean graft flow (MGF) and pulsatility index (PI) of the LIMA bridge were measured using transit time flow measurement (TTFM). The primary endpoint event in this study was cardiac death within 18 months after surgery. The Cox survival analysis showed that the MGF, the LIMAV and left ventricular ejection fraction (LVEF) were risk factors for death after CABG. The cut-offs of MGF, LIMAV and LVEF for the prediction of death after CABG were ≤ 14 mL/min (area under the curve (AUC): 0.830; sensitivity: 100%; specificity: 65.6%), ≤ 60 cm/s (AUC: 0.759; sensitivity: 65.5%; specificity: 85.3%), and ≤ 44% (AUC: 0.724; sensitivity: 50%; specificity: 88.5%), respectively. Compared with the use of MGF, MGF + LIMAV, combination of the MGF + LIMAV + LVEF (AUC: 0.929; sensitivity: 100%; specificity: 81.1%) resulted in a stronger predictive value (MGF vs. MGF + LIMAV + LVEF: P = 0.02). LIMAV measured by preoperative transthoracic ultrasound combined with intraoperative MGF and LVEF may have a greater value in predicting patients' risk of cardiac death after CABG.

Role of Transthoracic Ultrasound in Patient with Acute Dyspnea in Emergency Department

Role of Transthoracic Ultrasound in Patient with Acute Dyspnea in Emergency Department

The Accuracy of Various Lung Ultrasonography Findings in Predicting the Necessity for Surfactant Treatment in Neonates With Respiratory Distress Syndrome

Objective: The study was conducted to determine the value of various lung ultrasonography (LUS) findings in diagnosing neonatal respiratory distress syndrome (RDS) and to assess the ability of ultrasonography to predict the need for surfactant treatment. Materials and Methods: This cohort study was conducted on 164 neonates with RDS with a gestational age of over 28 weeks. Transthoracic sonography was performed in all patients in the infant isolet immediately after admission and stabilization of the infant and during the first 6 hours before surfactant treatment. Immediately after the sonogram, the neonates underwent an anterior–posterior view chest radiograph, before and after surfactant treatment. Results: In comparison with clinical manifestations and radiographic findings as the references, the sensitivity and specificity of each of the LUS-related parameters for detecting RDS were as follows: Faded A-lines (95.4% and 76.7%), abnormal B-lines (91.7% and 71.6%), the presence of consolidation (90.9% and 88.3%), the presence of pleural effusion (95% and 86.7%), and alveolar–interstitial syndrome (AIS) (98% and 96%). Conclusion: LUS findings were valuable in assessing and grading the severity of neonatal RDS alongside clinical evaluation. LUS may assist in selecting infants for surfactant therapy and monitoring treatment response.

Using lung ultrasound to guide PEEP determination in mechanically ventilated patients with acute respiratory distress syndrome

Supportive care with mechanical ventilation is the cornerstone of management for acute respiratory distress syndrome (ARDS). Positive end-expiratory pressure (PEEP) is often applied in mechanically ventilated patients with ARDS to improve oxygenation; however, determining the optimal PEEP level—the pressure that maximizes clinical benefit while minimizing risks of ventilator-induced lung injury and other harms—for each patient can be challenging. Recently, transthoracic lung ultrasonography (also called lung ultrasound) has been proposed as a tool to guide PEEP determination in patients with ARDS. This paper reviews the history of use of lung ultrasound as a method to guide PEEP determination and the four published studies which compared it to other techniques of PEEP determination, such as the oxygenation and PV-curve methods.

Ultrasonographic Applications in the Thorax.

Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units, it is also utilized in many clinical branches dealing with the respiratory system-due to its ease of use, fast access, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations-and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applications, such as the endobronchial ultrasound and esophageal ultrasound.

Assessment of Diaphragmatic Mobility by Transthoracic Ultrasound in Patients with Interstitial Lung Diseases

Background: As interstitial lung diseases may promote respiratory muscles dysfunction due to increased lung elastic recoil, chronic hypoxemia, systemic inflammation, physical inactivity, malnutrition and corticosteroids therapy. Therefore, measuring diaphragmatic function is quite helpful when assessing patients with interstitial lung disorders. Aim of the work: was to compare the diaphragmatic mobility which assessed by ultrasonography between healthy individuals and patients with interstitial lung diseases. Patients and Methods: this case-control trial, whereas Thirty patients with clinically stable interstitial lung diseases and twenty healthy persons as a control. Whereas age, sex and body mass index matched apparently in control group. Pulmonary functions tests: as six-minute walk test, ultrasonographic measurement of both diaphragmatic excursion and thicknesses at residual functional capacity and total lung capacity, with calculation of the diaphragmatic thickening fraction were done for all participants. Results: Diaphragmatic kinetics are greatly impaired in interstitial lung diseases patients at total lung capacity, but almost not affected at functional residual capacity. Diaphragmatic excursion and thickness at total lung capacity, as well as diaphragmatic thickening fraction showed considerable positive correlations with forced vital capacity and 6-minute walk distance, whereas they exhibited considerable negative correlations with modified Medical Research Council dyspnea scale. Conclusion: Diaphragmatic kinetics measured at total lung capacity and thickening fraction have good correlations with degree of dyspnea, forced vital capacity and exercise tolerance.

Utility of lung ultrasound in adjustment of the initial mechanical ventilation settings in patients with acute respiratory distress syndrome

Background Bedside lung ultrasound (US) is an essential tool in assessing lung aeration in severely ill patients. Aim The goal of this study was to determine the use of lung US in evaluating changes in lung aeration in dependent lung areas during positive end expiratory pressure (PEEP) titration in patients with acute respiratory distress syndrome (ARDS). Patients and methods A total of 52 mechanically ventilated patients with ARDS admitted in the ICU of Abbassia Chest Hospital were enrolled in this study. Transthoracic sonography was performed at the posterior axillary line on either side after 30 min of initial ventilator settings; recruitment at the end of expiration was sonographically assessed while changing PEEP. Arterial blood gases were performed before and after recruitment maneuver along with continuous monitoring of hemodynamics and oxygen saturation throughout the procedure. The procedure was terminated if the plateau pressure exceeded 30 cmH2O or if there was hemodynamic compromise. Results A total of 52 mechanically ventilated patients with ARDS were enrolled in the study. Overall, 80% had severe ARDS. Initial US assessments were done, and subpleural consolidation (C) was found in 18 patients, whereas exaggerated B lines (B) were found in 33 patients. After PEEP titration, under US guidance, 13 patients changed the US pattern from C to B and 22 patients changed from B to A (A-line pattern). These results correlated with improvement of PaO2/FiO2 ratio from 69.98 ± 27.93 to 86.21 ± 31.64 and increased compliance from 26.49 ± 8.63 to 28.73 ± 8.74. However, there was an increase in plateau pressure from 25.12 ± 3.88 to 27.98 ± 3.18, and also PaCO2 increased from 51.00 ± 16.05 to 58.52 ± 15.93. The mean arterial blood pressure decreased from 84.87 ± 7.91 to 81.60 ± 8.72. Conclusion US is an effective tool in achieving PEEP titration in mechanically ventilated patients with ARDS. US finding of aeration correlates well with improvement in oxygenation and compliance. However, the patients should be monitored for safe limits of pressures, hemodynamics, and PaCO2 level that may rise.

Prognostic implications of elevated pulmonary artery systolic pressure on 6-month mortality in elderly patients with acute myocardial infarction

Abstract Background Pulmonary artery systolic pressure (PASP) has often been evaluated as an indicator of heart failure, but the relationship between PASP and the prognosis of elderly patients with acute myocardial infarction (AMI) is not well understood. Methods The medical data of 3460 hospitalized elderly patients diagnosed with AMI between January 2013 and June 2018 were reviewed. PASP was calculated using transthoracic color Doppler ultrasonography. Patients were grouped according to their admission PASP results as follows: Group A, PASP ≤30 mmHg; Group B, 30 mmHg &lt;PASP ≤50 mmHg; and Group C, PASP ≥51 mmHg. The primary endpoint was all-cause death 6 months following AMI. Multiple Cox regression analysis was used to identify independent risk factors for 6-month mortality in elderly patients with AMI. Results PASP was associated with age, Killip classification, AMI site, and decreased ejection fraction in elderly patients. After adjusting for clinical and echocardiographic parameters in the Cox model, PASP was found to be significantly related to all-cause mortality. In receiver operating characteristic analysis, a PASP of &gt;34 mmHg had a sensitivity of 62.3% and specificity of 65.7% for predicting 6-month all-cause death after AMI. Conclusion PASP at admission is a useful marker for predicting short-term mortality in elderly patients with AMI. This finding could be used to help identify high-risk patients and make appropriate clinical decisions.

Implementation of evidence on management of pleural diseases: insights from a territory-wide survey of clinicians in Hong Kong

BackgroundMajor advances in management of common pleural diseases have taken place in the past decade. However, pleural diseases are often managed by physicians of diverse training background and research on implementation of new knowledge is scanty. We aim to evaluate the practice pattern in pleural medicine among physicians in Hong Kong, for identification of possible gaps for clinical service improvement.MethodsThe Hong Kong Thoracic Society undertook a cross-sectional questionnaire survey in 2019, targeting clinicians of various subspecialties in internal medicine and levels of experience (basic and higher trainees, specialists) from twelve regional hospitals of diverse service scopes throughout Hong Kong. Respondents were selected by non-probability quota sampling. The questionnaire tool consisted of 46 questions covering diagnostic and therapeutic aspects of common pleural diseases. The responses were anonymous, and analysed independently using SPSS statistics software.ResultsThe survey collected 129 responses, 47(36%) were from clinicians specialized in respiratory medicine. Majority of the respondents (98%) managed pleural diseases, including performing pleural procedures in their practice. Fifty-five percent of all the respondents had not received any formal training in transthoracic ultrasonography. A significant proportion of clinicians were unaware of pleuroscopy for investigation of exudative pleural effusion, indwelling pleural catheter for recurrent malignant pleural effusion, and combined intra-pleural Alteplase plus DNase for treatment of pleural infection (30%, 15% and 70% of non-respiratory clinicians respectively). Significant heterogeneity was found in the management of pleural infection, malignant pleural effusion and pneumothorax among respiratory versus non-respiratory clinicians. Contributing factors to the observed heterogeneity included lack of awareness or training, limited accessibility of drugs, devices, or dedicated service support.ConclusionSignificant heterogeneity in management of pleural diseases was observed among medical clinicians in Hong Kong. Continuous medical education and training provision for both specialists and non-specialists has to be strengthened to enhance the implementation of advances, improve quality and equity of healthcare provision in pleural medicine.

Utility of high-frequency B-mode and contrast-enhanced ultrasound for the differential diagnosis of benign and malignant pleural diseases: a prospective study.

Pleural disease is a prevalent condition. As precision therapy advances, noninvasive imaging modalities play even more important roles in the evaluation of pleural diseases. This study investigated the diagnostic capabilities of high-frequency B-mode ultrasound (US) and contrast-enhanced US (CEUS) in terms of differentiating between benign and malignant pleural diseases. Patients with unexplained thickened pleurae were prospectively analyzed via transthoracic US. High-frequency B-mode US was used to derive the pleural thickness, morphology, and echogenicity. We analyzed the high-frequency CEUS data including the enhancement mode and time intensity curve (TIC). The cause of pleural thickening was confirmed by pleural biopsy and follow-up after the biopsy. We analyzed the differences in various ultrasonic features between the malignant and benign groups. Moreover, we plotted receiver operator curves (ROCs) and obtained the area under the curves, sensitivities, and specificities of all significant continuous variables. Multivariate logistic regression was used to assess the combined usefulness of multiple US indicators in terms of predicting malignant pleurae. Thirty malignant and twenty benign thickened pleurae were finally diagnosed via pleural biopsy and at least six months of follow-up. The pleural morphology and enhancement modes significantly differed between the two groups (all P<0.05). The thickness derived from B-mode US and CEUS were significantly thicker in the malignant group (both P<0.05). Arrival time (AT) and the time to peak (TTP) of TIC were significantly shorter in the malignant group, whereas peak intensity and the area under the TIC were significantly higher in the malignant group (all P<0.05). The area under the ROC for pleural thickness derived from B-mode US was 0.819; pleural thickness derived from CEUS was 0.848; AT was 0.804; TTP was 0.750; peak intensity was 0.745; the area under the TIC was 0.743; and the combined various B-mode and CEUS parameter was 0.975. Pleural thickness, morphology, enhancement mode, and the TIC of high-frequency US aided the differentiation of benign from malignant pleural diseases. Combined analysis of US indicators further improved the diagnostic capability.

Lung consolidation as an acoustic window to superior vena cava by transthoracic ultrasonography in the intensive care unit.

Lung consolidation as an acoustic window to superior vena cava by transthoracic ultrasonography in the intensive care unit.

To scan or not to scan? The economics of transthoracic ultrasonography for 'whole-flock' ovine pulmonary adenocarcinoma screening in UK sheep flocks.

Transthoracic ultrasonography (TTUS) is currently the only widely used method to diagnose suspected preclinical or subclinical cases of ovine pulmonary adenocarcinoma/Jaagsiekte (OPA) in live sheep. However, the economic impact of using TTUS as a screening test has not been described previously. Test characteristics for TTUS in a low-prevalence situation were obtained from a previous study of 1074 breeding ewes that underwent TTUS with an experienced operator. The economic impact was modelled using a 10,000-iteration partial budget simulation and probability sensitivity analysis to explore the relative influence of model variables. In flocks of this size, culling true-positive and false-positive cases resulted in an estimated median net loss of £4647 (interquartile range: £3537-£6006), determined primarily by replacement ewe value and the cost of TTUS per ewe. The results of this study emphasise that great caution should be exercised by practitioners when determining if TTUS is appropriate as a screening test for OPA in low-prevalence flocks or subpopulations within a flock, such as younger age groups, where the losses incurred through the inadvertent culling of healthy sheep may significantly exceed any benefit derived from culling preclinical/subclinical cases.

How useful is transthoracic ultrasonography for detecting ovine pulmonary adenocarcinoma in sheep?

How useful is transthoracic ultrasonography for detecting ovine pulmonary adenocarcinoma in sheep?

Accuracy of Transthoracic Ultrasound in the Diagnosis of Different Pleural and Pulmonary Diseases: Zagazig University Experience

Recently, there is an increase application of chest ultrasound to evaluate and monitor pleuropulmonary diseases. Computed tomography (CT) is the gold standard for most different lung pathologies with limitations. This study aims to assess the effectiveness of Chest Ultrasound compared to Computed Tomography in diagnosis of different pleuropulmonary disorders and to define the rules of chest ultrasound in pulmonary medicine. This study was conducted upon randomly selected 110 patients with different pleuropulmonary disorders who were admitted to the respiratory ward and ICU, Zagazig University Hospitals, from April 2018 to April 2020. All patients with abnormal chest X. ray opacities were evaluated for complete history taking, full clinical examination, laboratory investigations, then Chest US was performed on the first day of admission then CT was done as a gold standard for the final diagnosis then results of both Chest US and CT were compared. Compared to CT, Chest US had sensitivity (95.8%) for free pleural effusion diagnosis, specificity (90.3%), and (92.7%) accuracy; for pneumonia, (90.9%), (96.1%), and (94.5%) respectively, while pneumothorax had (81.8%), (98%), and (96.3%) accuracy, respectively; for pulmonary edema, (89.5%), (97.8%), and (96.4%) accuracy, respectively. The US plays a valuable role in the diagnosis of different pleuropulmonary diseases and can be used as the first routine radiological modality in both ward &amp; ICU.

Efficacy of high-throughput transthoracic ultrasonographic screening for on-farm detection of ovine pulmonary adenocarcinoma.

The aim of this study was to evaluate the efficacy of high-throughput on-farm transthoracic ultrasound (TUS) to screen for ovine pulmonary adenocarcinoma (OPA), an infectious ovine disease of increasing concern. No other routine diagnosis of preclinical OPA is available, or any vaccine or treatment. More than 80,000 rapid TUS scans were applied on farms with a history of OPA. The TUS results from a convenience sample of 171 TUS-negative and 269 TUS-positive sheep were compared with postmortem histology/immunohistochemistry results, the 'gold standard' reference test for OPA diagnosis. These results, together with new data on within-flock prevalence, allowed estimation of the efficacy of rapid TUS screening to identify OPA (defined as tumours of larger than 1cm) on-farm. The TUS screening had an estimated specificity of 0.998 (95% confidence interval [CI]: 0.998-0.999) and an estimated sensitivity of between 0.76 (95% CI: 0.72-0.79) and 0.99 (95% CI: 0.97-0.99) depending on the presumed false-negative rate applied to the calculation. High-throughput TUS should be considered for screening to identify individual sheep with OPA and has potential application to indicate flocks at low risk of OPA. However, lower efficacy is likely if conducted by less experienced persons.

New biomarkers for the diagnosis of pleural effusion

BackgroundPersistent undiagnosed effusion is present in approximately 15% of all causes of exudative effusion. Pleural effusion caused by immunoglobulin G4 (IgG4) is a new type of pleural effusion. Tumor markers such as Carcinoembryonic antigen (CEA) may play a role in the diagnosis of malignant pleural effusion. This study aimed to evaluate the use of serum Immunoglobulin G4 and carcinoembryonic antigen in diagnosing pleural effusion.MethodsThis observational descriptive cross-sectional study comprised 89 individuals with exudative pleural effusion who visited the Assiut university hospital's chest department. All patients were examined and asked about their medical history. Also, chest X-ray, MSCT chest, transthoracic ultrasonography, pleural fluid analysis and cytology, serum level of carcinoembryonic antigen, and immunoglobulin G4 were performed. In addition, pleural biopsy, bronchoscopy, and thoracoscopy were performed when required.ResultsIn comparison to another diagnosis, the level of serum IgG 4 was observed to be substantially greater in individuals with IgG4-associated effusion (725± 225.45). Patients with malignant mesothelioma (70± 16.24) and metastatic adenocarcinoma (93.52± 19.34) had lower levels of IgG4. In contrast, the serum level of CEA was significantly higher in individuals with malignant mesothelioma (79.50± 29.47) and metastatic adenocarcinoma (68.71± 28.98). Patients with para-pneumonic effusion had a minor serum level of CEA (0.36 ± 0.26). At cutoff point > 152 mg/dl serum IgG-4 had 100% sensitivity and 94% specificity in the diagnosis of IgG4 related pleural effusion with an overall accuracy of 95.3% and area under the curve of 0.97. At the cutoff point > 5 ng/ml serum CEA had 77% sensitivity and 100% specificity in diagnosing malignant pleural effusion with an overall accuracy of 91.1% and area under the curve of 0.88.ConclusionSerum IgG4 higher than 152 mg/dl has good diagnostic accuracy in cases of undiagnosed pleural effusion. Carcinoembryonic antigen aids in diagnosing malignant pleural effusion with a cutoff point higher than 5 ng/ml in serum.Trial registrationClinicalTrials.gov registration ID NCT03260088