Prognostic Role of Incidental Pleural Effusion Diagnosed During Echocardiographic Evaluation

Abstract

Background: The purpose of this study was to determine the long-term prognostic implications of incidental pleural effusion (PE) detected during echocardiographic examination and its relationship with concomitant diseases. Hypothesis: The study hypothesis is to test whether incidental pleural PE detected during echocardiographic examination be used as a prognostic marker. Methods: The study was performed by evaluating patient records (N = 251) in whom PE was incidentally detected during echocardiographic examination in a tertiary hospital between 1999 and 2012. The patients were classified into 4 major groups according to the concomitant primary disease: malignancy, and cardiovascular, renal, and pulmonary diseases. The total survival time was obtained from hospital records for patients who died during the hospital stay and social security institution records for patients with out-of-hospital death. Results: One-year and 5-year life expectancies of PE cases concomitant with different disorders were as follows; heart failure (n = 151), 81% and 70%; malignancies (n = 45), 53% and 44%; pulmonary diseases (n = 37), 89% and 78%; renal diseases (n = 18), 100% and 83%; respectively. PE associated with heart failure, renal disease, and pulmonary disease had similar (P > 0.05 for all) and favorable outcomes compared to PE associated with malignancies (P < 0.001). Conclusions:The prognosis of incidental PE was the worst in patients with concomitant malignancies; however, PE associated with nonmalignant diseases including heart failure, pulmonary disease, and renal disease have similar and favorable outcomes.

Lung Ultrasound Findings Detected During Inpatient Echocardiography Are Common and Associated With Short‐ and Long‐term Mortality

“…In a previously reported retrospective review of 251 consecutive echocardiograms with incidentally detected left pleural effusions during standard echo imaging, an association with high 1-year (range, 0%-47%) and 5-year (range, 22%-56%) mortality was noted, depending on the etiology of the effusion, and was particularly worse in patients with malignancy. 20 Our study used 2 dedicated posterobasal coronal views of both lungs specifically for detection of smaller amounts of pleural fluid by visualization of the diaphragm as a landmark 3,12,32 and found a similar association with mortality.…”

“…Echocardiography is a frequently ordered initial test for the evaluation of suspected cardiopulmonary disease, and the same US transducer used in echocardiography can be used to detect pleural effusions or US B-lines [12][13][14][15]20 that form in the presence of interstitial lung edema. As few data exist regarding whether such lung findings have sufficient prevalence and prognostic importance in patients to warrant imaging during the initial echo study, we sought to review the outcomes of consecutive patients referred for echocardiography in which a 4-view US lung examination had been incorporated into the standard transthoracic echocardiogram.…”

Mortality Among Hospitalized Patients With Pleural Effusions. A Multicenter, Observational, Prospective Study

“…In a prospective study of 100 patients, PE didn't predict outcome or mortality during a 6-month follow-up ( 17 ). Ercan and colleagues reported favorable survival (81% at 1 year, n = 151) when effusions were incidentally observed in transthoracic echocardiogram ( 18 ). However, recent prospective studies report high mortality at 1 year (near 50%), suggesting that HF-related PEs, especially large refractory cases requiring aspiration, have a poor prognosis ( 10 , 11 ).…”

Creating a Novel Cardiac Limited Ultrasound Exam Curriculum for Internal Medical Residency: Four Unanticipated Tasks

“…19 The basal pleural spaces are viewed for the effusion sign, the presence of dark fluid present posteriorly in the costophrenic or costovertebral spaces. The presence of apical comet tails or basilar pleural effusions has demonstrated diagnostic accuracy, 20,21 are associated with a poor prognosis, 22–25 and can be easily learned. 26 Lastly, the subcostal view evaluates right ventricular enlargement and inferior vena cava (IVC) plethora and serves as an alternate view of the left ventricle when the parasternal view is poor or inaccessible.…”