Point of Care Ultrasound for the General Internist: Pleural Effusions
Pleural effusions are a common finding in many clinical settings and have important diagnostic and therapeutic implications. They may be identified by physical exam, chest radiography, chest computerized tomography (CT) scans or point of care ultrasonography (POCUS). The use of POCUS for the diagnosis and management of pleural effusions offers several advantages relevant to the practice of the general internist. For the diagnosis of pleural effusion, POCUS has superior sensitivity and specificity when compared to chest radiography and physical exam. Abnormal sonographic features of the pleural fluid and the adjacent pleura may suggest the presence of an exudative or malignant effusion. POCUS can be used to quickly estimate the size of a pleural effusion. Lastly, the use of ultrasound guidance when performing a thoracentesis reduces the risk of pneumothorax and hemorrhage.
Puchalski JT. Mortality of Hospitalized Patients with Pleural Effusions. Journal of Pulmonary & Respiratory Medicine 2014;04(03).
Vignon P, Chastagner C, Berkane V, et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography*. Critical Care Medicine 2005;33(8):1757–63.
Gordon CE. Pneumothorax Following Thoracentesis. Archives of Internal Medicine 2010;170(4):332.
Patel PA, Ernst FR, Gunnarsson CL. Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures. J Clin Ultrasound 2012;40(3):135–41.
Yousefifard M, Baikpour M, Ghelichkhani P, et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emerg (Tehran) 2016;4(1):1–10.
Schleder S, Dornia C, Poschenrieder F, et al. Bedside diagnosis of pleural effusion with a latest generation hand-carried ultrasound device in intensive care patients. Acta Radiologica 2012;53(5):556–60.
Begot E, Grumann A, Duvoid T, et al. Ultrasonographic identification and semiquantitative assessment of unloculated pleural effusions in critically ill patients by residents after a focused training. Intensive Care Med 2014;40(10):1475–80.
Wong CL, Holroyd-Leduc J, Straus SE. Does this patient have a pleural effusion? JAMA 2009;301(3):309–17.
Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby J-J. Comparative Diagnostic Performances of Auscultation, Chest Radiography, and Lung Ultrasonography in Acute Respiratory Distress Syndrome. Anesthesiology 2004;100(1):9–15.
Tayal VS, Nicks BA, Norton HJ. Emergency ultrasound evaluation of symptomatic nontraumatic pleural effusions. The American Journal of Emergency Medicine 2006;24(7):782–6.
Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. American Journal of Roentgenology 1992;159(1):29–33.
Chian C-F, Su W-L, Soh L-H, Yan H-C, Perng W-C, Wu C-P. Echogenic swirling pattern as a predictor of malignant pleural effusions in patients with malignancies. Chest 2004;126(1):129–34.
Chen H-J, Tu C-Y, Ling S-J, et al. Sonographic appearances in transudative pleural effusions: not always an anechoic pattern. Ultrasound in Medicine & Biology 2008;34(3):362–9.
Görg C, Restrepo I, Schwerk WB. Sonography of malignant pleural effusion. Eur Radiol 1997;7(8):1195–8.
Bugalho A, Ferreira D, Dias SS, et al. The Diagnostic Value of Transthoracic Ultrasonographic Features in Predicting Malignancy in Undiagnosed Pleural Effusions: A Prospective Observational Study. Respiration 2014;87(4):270–8.
Balik M, Plasil P, Waldauf P, et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 2006;32(2):318–21.
Usta E, Mustafi M, Ziemer G. Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients. Interactive CardioVascular and Thoracic Surgery 2010;10(2):204–7.
Remérand F, Dellamonica J, Mao Z, et al. Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med 2010;36(4):656–64.
Roch A, Bojan M, Michelet P, et al. Usefulness of Ultrasonography in Predicting Pleural Effusions > 500 mL in Patients Receiving Mechanical Ventilation. Chest 2005;127(1):224–32.
Havelock T, Teoh R, Laws D, Gleeson F, BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii61–76.
McLoud TC, Flower CD. Imaging the pleura: sonography, CT, and MR imaging. American Journal of Roentgenology 1991;156(6):1145–53.