Sonographic evaluation of unexplained pleural exudate: a prospective case series

Marčun, Robert; Šustić, Alan

doi:10.1007/s00508-009-1188-5

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…Figure 1 illustrates the study selection process. After removing duplicates, we screened 504 articles and included seven studies after applying the exclusion criteria [8][9][10][11][12][13]16]. Table 2).…”

Section: The Protocol Of This Systematic Review Was Registered In Thementioning

confidence: 99%

“…The international guidelines recommended ultrasound guidance when performing diagnostic thoracentesis to reduce the risk of complications [6,7]. Many recent, studies have explored the utility of morphological findings of transthoracic ultrasound (TUS) as a tool for detecting MPE [8][9][10][11][12][13][14]. However, these studies had a small sample size and were conducted at a single centre; hence, the diagnostic accuracy of TUS remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Thoracic ultrasound for malignant pleural effusion: a systematic review and meta-analysis

et al. 2020

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This systematic review aimed to evaluate the diagnostic accuracy of thoracic ultrasound in malignant pleural effusion.Articles published until December 2019 in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the International Clinical Trials Registry Platform were screened by two authors independently to extract data and evaluate the risks of bias and applicability using the modified Quality Assessment of Diagnostic Accuracy Studies-2 tool. We described the forest plots of each thoracic ultrasound finding. We estimated the pooled sensitivity and specificity of pleural nodularity using the bivariate random-effects model.We included seven articles and found that each thoracic ultrasound finding had low sensitivity. The pooled specificity of pleural nodularity was 96.9% (95% confidence interval, 93.2%–98.6%).In conclusion, thoracic ultrasound is not useful in ruling out malignant pleural effusion. Physicians can proceed rigorously to repeat thoracentesis or other invasive procedures when pleural nodularity is detected.

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Section: The Protocol Of This Systematic Review Was Registered In Thementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thoracic ultrasound for malignant pleural effusion: a systematic review and meta-analysis

et al. 2020

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“…53,54 Exudative effusions from tuberculosis, malignancy, or other etiologies more often include debris, septations, or other complex features. 55,56 Certain features such as a swirling debris, pleural thickening, and nodularity may be more often associated with malignancy, 54,56 and advanced ultrasound techniques may be used to detect a trapped lung prior to attempting drainage of a malignant pleural effusion. 57 Two studies found complex septated pleural effusions to be invariably exudative 50,58 and drainage was unlikely to be successful without the placement of a chest tube.…”

Section: We Recommend That Ultrasound Should Be Used To Detect the Prmentioning

confidence: 99%

Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine

Dancel

Schnobrich

Puri

et al. 2018

Journal of Hospital Medicine

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Executive Summary: 1) We recommend that ultrasound should be used to guide thoracentesis to reduce the risk of complications, the most common being pneumothorax. 2) We recommend that ultrasound guidance should be used to increase the success rate of thoracentesis. 3) We recommend that ultrasound-guided thoracentesis should be performed or closely supervised by experienced operators. 4) We suggest that ultrasound guidance be used to reduce the risk of complications from thoracentesis in mechanically ventilated patients. 5) We recommend that ultrasound should be used to identify the chest wall, pleura, diaphragm, lung, and subdiaphragmatic organs throughout the respiratory cycle before selecting a needle insertion site. 6) We recommend that ultrasound should be used to detect the presence or absence of an effusion and approximate the volume of pleural fluid to guide clinical decision-making. 7) We recommend that ultrasound should be used to detect complex sonographic features, such as septations, to guide clinical decision-making regarding the timing and method of pleural drainage. 8) We suggest that ultrasound be used to measure the depth from the skin surface to the parietal pleura to help select an appropriate length needle and determine the maximum needle insertion depth. 9) We suggest that ultrasound be used to evaluate normal lung sliding pre- and postprocedure to rule out pneumothorax. 10) We suggest avoiding delay or interval change in patient position from the time of marking the needle insertion site to performing the thoracentesis. 11) We recommend against performing routine postprocedure chest radiographs in patients who have undergone thoracentesis successfully with ultrasound guidance and are asymptomatic with normal lung sliding postprocedure. 12) We recommend that novices who use ultrasound guidance for thoracentesis should receive focused training in lung and pleural ultrasonography and hands-on practice in procedural technique. 13) We suggest that novices undergo simulation-based training prior to performing ultrasound-guided thoracentesis on patients. 14) Learning curves for novices to become competent in lung ultrasound and ultrasound-guided thoracentesis are not completely understood, and we recommend that training should be tailored to the skill acquisition of the learner and the resources of the institution.

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“…40,41 Not only is ultrasound better at determining if a pleural effusion is present, it can also reliably provide insight into the type of pleural effusion present (hemothorax, complicated effusion, multiloculated effusion, empyema, transudate, or exudate), which may change the management approach. [42][43][44] Arguably the most important finding is that ultrasound significantly improves safety of pleural procedures with improved site selection and less accidental organ puncture. 45 Ultrasound assistance with site selection also decreases pneumothoraces but only with realtime needle puncture or immediate preprocedural marking of the site.…”

Section: Pleural Effusionmentioning

confidence: 99%

Ultrasound-Guided Pleural Access

Shojaee

Argento

2014

Semin Respir Crit Care Med

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Ultrasonography of the thorax has become a more recognized tool in pulmonary medicine, thanks to continuing clinical research that has proven its many valuable roles in the day-to-day management of pulmonary and pleural diseases. Ultrasound examination is a cost-effective imaging modality that permits the pulmonologist to obtain information about the pathologies in the thorax without the risk of exposure to ionizing radiation, providing the examiner with real-time and immediate results. Its ease of use and training along with its portability to the patient's bedside and accurate examination of the pleural space has allowed for safer pleural procedures such as thoracentesis, chest tube placement, tunneled pleural catheter placement, and medical thoracoscopy. In this review, we summarize the technique of chest ultrasonography, compare ultrasound to other frequently used thoracic imaging modalities, and focus on its use in obtaining pleural access while performing invasive pleural procedures.

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Sonographic evaluation of unexplained pleural exudate: a prospective case series

Cited by 5 publications

References 15 publications

Thoracic ultrasound for malignant pleural effusion: a systematic review and meta-analysis

Thoracic ultrasound for malignant pleural effusion: a systematic review and meta-analysis

Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine

Ultrasound-Guided Pleural Access

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