Parietal pleural changes in empyema: appearances at CT.

Waite, Richard J.; Carbonneau, R J; Balikian, Jirayr P.; Umali, Cynthia B.; Pezzella, A. Thomas; Nash, Gerald D.

doi:10.1148/radiology.175.1.2315473

Cited by 155 publications

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“…Likewise, they observed pleural thickening only in exudative effusions with sensitivity of 42% and specificity 100%. Waite and colleagues [13] observed the same finding for pleural thickening in differentiating between exudative and transudative effusions. Aquino et al8 among 86 patients with pleural effusion, also observed pleural thickening only in one patient with transudative and 36 patients with exudative effusions with sensitivity of 61% and specificity of 96%.…”

Section: Discussionmentioning

confidence: 57%

The Accuracy of Chest Computed Tomography Findings in Differentiation of Exudative from Transudative Pleural Effusion

Rashid¹,

Jalili²,

Arhami³

et al. 2015

Ann Clin Anal Med

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ÖzetAmaç: Tomografinin(CT) transuda veya eksuda ayırımında kullanımı tartış-malıdır. Bu çalışmanın amacı CT'nin plevral effüzyonun karakterini belirlemede yararlı olup olmadığını değerlendirmektir. Gereç ve Yöntem: Plevral effüz-yonu olup Toraks CT ve diyagnostik torasentez yapılan 100 hasta değerlendi-rildi. Effüzyonlar Light kriterlerine göre eksuda ve transuda olarak sınıflandı-rıldı. CT'ler effüzyonun , lokulasyon ve plevral kalınlaşma gibi diğer CT özellik-lerinin ortalama Hounsfield değerlerini belirlemek için 2 radyolog tarafından değerlendirildi. Bulgular: Plevral sıvı 58 hastada eksuda; 42 hastada transudaydı. Eksudatif effüzyonda transudaya göre belirgin olarak yüksek ortalama atenüasyon değerleri(8.1±5.69 vs. 3.53±4.23 HU;p<0,001), yüksek lokulasyon (%91.4 vs. %64.3;p=0,002) ve yüksek plevral kalınlaşma (%50.9 vs. %19.5; p=0,002) değerleri vardı. Eksuda,transuda ayırımında sensitivite,spesifite >4.5 HU'da atenüasyon değeri için %74.6 ve %62.5, lokülasyon için %66,25 ve %75;plevral kalınlaşmada %78.38 ve %54.10'du. Tartışma: Atenüasyon değeri ve lokulasyon diğer özelliklerle karşılaştırıldığında göreceli olarak iyi sensitivite ve spesifiteye sahipti ve effüzyonların ayırımında daha iyi olabilirdi. Ancak,torasentez ile karşılaştırıldığında, Effüzyonun natürünü değerlendir-mek için CT daha güvenli bir metod değildir. Torasentezin kontrendike olduğu vakalarda daha kullanışlı olabilir. Anahtar KelimelerPlevral Efüzyon; Eksuda; Transuda; Bilgisayarlı Tomoğrafi; Atenüasyon Abstract Aim: There is a controversy in the usefulness of computed tomography (CT) in differentiating transudate or exudates. The aim of this study is to evaluate the utility of CT in characterizing pleural effusions. Material and Method: We evaluated 100 patients with pleural effusions who underwent chest CT and diagnostic thoracentesis. Effusions were classified as exudates or transudative on the basis of Light's criteria. CTs were reviewed by two radiologists to determine the mean Hounsfield unit value of an effusion and other CT features including loculation and pleural thickening. Results: Pleural fluid was exudative in 58 patients and transudative in 42 patients. Exudative effusion significantly had higher mean attenuation values (8.1±5.69 vs. 3.53±4.23 HU; p<0.001), higher loculation (91.4% vs. 64.3%; p=0.002) and higher pleural thickening (50.9% vs. 19.5%; p=0.002) than transudative effusion. Sensitivity and specificity in differentiating exudative from transudative effusion was 74.46% and 62.5% for attenuation value of >4.5 HU, 66.25% and 75.00% for loculation, and 78.38% and 54.10% for pleural thickening. Discussion: Attenuation value and loculation had relatively good sensitivity and specificity in comparison to other features and could better differentiate between effusions. However, in comparison to thoracentesis, CT scan is not a more reliable method to evaluate the nature of the effusion and would be useful only in cases with contraindications of thoracentesis.

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Section: Discussionmentioning

confidence: 57%

The Accuracy of Chest Computed Tomography Findings in Differentiation of Exudative from Transudative Pleural Effusion

Rashid¹,

Jalili²,

Arhami³

et al. 2015

Ann Clin Anal Med

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“…It is vital to have adequate enhancement of the pathological pleura so that it can be seen in patients with empyema and malignant effusions [3,[8][9][10]. Waite et al [9] demonstrated that 96% of patients with empyema and up to 10% of patients with malignant effusions showed parietal pleural enhancement; 95% of the latter are metastatic in origin, with common primaries being lung and breast, while mesothelioma accounts for 5% [11].…”

Section: Discussionmentioning

confidence: 99%

“…Waite et al [9] demonstrated that 96% of patients with empyema and up to 10% of patients with malignant effusions showed parietal pleural enhancement; 95% of the latter are metastatic in origin, with common primaries being lung and breast, while mesothelioma accounts for 5% [11]. Localised fibrous tumours involving the pleura also exhibit intense homogeneous contrast enhancement on CT [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols

Raj¹,

Kirke²,

Bankart³

et al. 2011

BJR

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Objectives: Imaging of the pleura by multidetector CT (MDCT) can be challenging. There is no clear evidence or guidelines on contrast infusion parameters for imaging pleura. We compared two contrast protocols for assessing pleural pathology on MDCT.Methods: This was a prospective study in which consecutive patients with MDCT for suspected pleural disease on chest radiograph were randomised into two groups. The first group received 150 ml of intravenous contrast at a rate of 2.5 ml s -1 and the second group received 100 ml at 2 ml s -1. Images were acquired after a 60 s delay. Hounsfield units of the pleura, thoracic aorta, main pulmonary artery, portal vein and superior mesenteric artery were measured and analysed by two independent readers. Results: 40 patients (20 in each group) who had pleural enhancement on MDCT were included for final analysis. The mean pleural enhancement value was 83 HU (Group A) vs 59 HU (Group B) (p50.0004). The mean aortic enhancement was 241 HU (A) vs 141 HU (B) (p,0.0001); main pulmonary artery enhancement was 208 HU (A) vs 139 HU (B) (p,0.0002); portal venous enhancement was 169 HU (A) vs 115 HU (B) (p,0.0001); and the superior mesenteric artery enhancement was 215 HU (A) vs 128 HU (B) (p,0.0001). Conclusion: Enhancement of the pleura and major vessels was significantly higher in the group receiving more contrast at a greater infusion rate. This technique of a single scan through the entire pleural surface with a delayed acquisition is promising. When pleural disease is suspected, contrast infusion protocols should be modified to achieve the best results and clinicians should be encouraged to specifically request a ''pleural CT''.

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“…There are two possible explanations for the higher prevalence of RPT reported by MARTINEZ et al [9]: 1) the patients had more severe illness compared with the present study; and 2) the patients were studied, for a second time, 3 rather than 6 months (as in the present study) after discharge. WAITE et al [12] evaluated the chest tomography scans in 35 patients with empyema within 2 weeks of a thoracentesis demonstrating an empyema. They reported only two from a total of 35 patients with RPT w5 mm.…”

Section: Discussionmentioning

confidence: 99%

Prognostic features of residual pleural thickening in parapneumonic pleural effusions

Castro¹,

Díaz²,

Pérez-Rodríguez³

et al. 2003

Eur Respir J

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The objective of the study was the identification of predictive factors for the development of residual pleural thickening (RPT) in patients with parapneumonic effusion.The design of the prospective study involved investigating patients with parapneumonic pleural effusions diagnosed between March 1991 and December 2000 in the respiratory department of Hospital Ramón y Cajal (Madrid, Spain) which is a 1,500 tertiary-care hospital.The clinical and radiological characteristics and measurements of microbiological and biochemical variables in the pleural fluid taken from the patients were studied. RPT was defined in a posteroanterior chest radiograph as pleural thickening of o10 mm measured at the lateral chest wall at the level of an imaginary line, tangent to the diaphragmatic dome.A total of 48 of the 348 patients studied (13.79%) were found to have RPT. Among the factors studied, only presence of pus in the pleural space, Fine classes IV and V, temperature o38uC and delayed resolution of pleural effusions after diagnosis (w15 days) were independently associated with the risk of RPT.This study showed that significant residual pleural thickening was not a common complication of parapneumonic pleural effusions. There are certain risk factors for the development of residual pleural thickening. However, this complication was not associated with long-term functional repercussions in the series of patients involved in this study. Despite the advent of potent antibiotics, bacterial pneumonia still results in morbidity and mortality. The annual incidence of bacterial pneumonia is estimated to range from 1.8-8 cases per 1,000, withy20% requiring hospitalisation [1]. It has been reported that 57% of hospitalised patients with bacterial pneumonia have an accompanying pleural effusion [2][3][4]. The morbidity and mortality rates in patients with pneumonia and pleural effusions are higher than in patients with pneumonia alone [5]. Most pleural effusions associated with pneumonia resolve without any specific therapy directed toward the pleural fluid [2], however y10% require operative intervention for their resolution. Delay in implementing proper therapy for these effusions is responsible for much of the morbidity, which can be substantial. This delay can lead to characteristic changes in the pleural space, including loculations and pleural thickening [6].Previous studies have assessed what features predict pleural thickening in tuberculous pleural effusions [7,8], however only one study has retrospectively analysed predictive factors for the development of residual pleural thickening (RPT) in parapneumonic pleural effusions (PPE) [9]. Moreover, there are no studies addressing if RPT is associated with long-term functional consequences in this group of patients.The purpose of the present study was to prospectively evaluate the prognostic features of RPT and its functional repercussions in a consecutive series of patients with PPE. The authors therefore hypothesise that RPT is an uncommon complication of PPE and is no...

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Parietal pleural changes in empyema: appearances at CT.

Cited by 155 publications

References 0 publications

The Accuracy of Chest Computed Tomography Findings in Differentiation of Exudative from Transudative Pleural Effusion

The Accuracy of Chest Computed Tomography Findings in Differentiation of Exudative from Transudative Pleural Effusion

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols

Prognostic features of residual pleural thickening in parapneumonic pleural effusions

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