Diagnostic Accuracy of Lateral Decubitus Chest Radiography before Pleural Maneuvers for the Management of Pleurisies in the Era of Chest Ultrasound

Abstract

Background: Chest ultrasound (CUS) is the gold standard to detect pleural adhesions before pleural maneuvers. However, the CUS technique is not available in all countries where the assessment is only based on clinical examination and chest radiography. Objective: To assess the value of lateral decubitus chest radiography (LDCR) to detect pleural adhesions. Methods: Consecutive patients with pleural effusions undergoing LCDR followed by medical thoracoscopy the day after were identified from an institutional database. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for LDCR were calculated. Results: Eighty-six patients were included in the study. The sensitivity, specificity, PPV, and NPV of LDCR for the presence of adhesions taking into account the shape of the horizontal level were 71.2% (56.7–82.5), 44.1% (27.6–61.9), 66.1% (52.1–77.8), and 50% (31.7–68.3), respectively. The accuracy to predict pleural adhesions for the sign “incomplete horizontal level” was 60.5 (49.3–70.7). The accuracy to predict pleural adhesions in case of irregular aspect of the horizontal level was 53.5 (42.5–64.2). Conclusions: The accuracy of LDCR for the detection of pleural adhesions is low in patients with pleural effusion and LDCR is not sufficient before pleural maneuvers. This has to be taken into account in countries with a high prevalence of pleural tuberculosis which usually lead to loculated pleural effusions. CUS has to be urgently included in dedicated educational programs in these areas in order to decrease the complications related to unexpected pleural adhesions and achieve better planning for the management of pleural effusions.

Lateral decubitus chest radiography or chest ultrasound to predict pleural adhesions before medical thoracoscopy: a prospective study

“…According to our results, the accuracy of LDCR is lower than CUS evaluation of the pleural cavity. The LDCR data collected are similar to the data we found for a previous cohort including 86 patients which was the rationale of the current study (10). Again, the assumption that an incomplete/segmented horizontal level on LDCR being suggestive of pleural adhesions was not verified and the LDCR failed in this intent-to-diagnose pleural adhesion study.…”

“…However, there are countries where the CUS technique is not available so far and where the pleural approach is only based on clinical examination and chest radiography. A recent prospective study aiming to assess the diagnostic accuracy of lateral decubitus chest radiography (LDCR) on the affect side before pleural maneuvers showed a positive predictive value (PPV) and negative predictive value (NPV) for the detection of pleural adhesions of 66.1% and 50% respectively (10). Therefore, this simple imaging technique can be useful in some cases in the area without any access to CUS procedures.…”

Exeunt Lateral Decubitus Radiographs

“…In this issue of Respiration , Thiam et al have contributed to the data on identification of pleural fluid loculations via the lateral decubitus radiograph [5]. The utility of identifying loculated effusions is not in question: it is acknowledged that a loculated effusion is more likely to progress to empyema, has prognostic implications, and predicts the success or failure of the chosen intervention.…”