Sonographic Septation in Lymphocyte-Rich Exudative Pleural Effusions

Chen, Hung Jen; Hsu, Wu Huei; Tu, Chih Yen; Yu, Yang; Chiu, Kuo Liang; Hang, Liang Wen; Hsia, Te Chun; Shih, Chuen Ming

doi:10.7863/jum.2006.25.7.857

Cited by 25 publications

(26 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that although this US pattern can appear in both MPE and non-MPE effusions it is significantly more common in the nonmalignant group, associated with infectious disorders, namely tuberculosis and pneumonia. Our results are supported by the 30-month retrospective study of Chen et al [22] which stated that an US septated pattern was a predictor of tuberculosis in lymphocyte-rich exudative pleural effusions [22]. The higher incidence of tuberculosis in some studies (15 cases in 67 non-MPE in our study) might explain the described differences in the varying studies [11].…”

Section: Discussionsupporting

confidence: 78%

The Diagnostic Value of Transthoracic Ultrasonographic Features in Predicting Malignancy in Undiagnosed Pleural Effusions: A Prospective Observational Study

Bugalho

Ferreira

Dias³

et al. 2014

Respiration

View full text Add to dashboard Cite

Background: Transthoracic ultrasound (US) is an important instrument to identify pleural effusions and safely conduct invasive procedures. It also allows systematic scanning of the pleural surface, though its value remains uncertain for differentiation between malignant (MPE) and nonmalignant pleural effusion (non-MPE) in routine clinical practice. Objectives: To evaluate the utility of US features to predict malignancy in undiagnosed pleural effusions in a real-life clinical setting. Methods: The US features of 154 consecutive patients with a pleural effusion were prospectively assessed. Anonymous images were recorded by an operator blinded to the clinical and radiological results. The US findings were classified by independent reviewers and compared to the final diagnosis. Results: A total of 133 patients were included (age 67 ± 16 years; BMI 25.1 ± 4.6; 54.1% females). The final diagnosis was MPE in 66 cases and non-MPE in 67 cases. US had an overall sensitivity of 80.3%, a specificity of 83.6%, and positive and negative predictive values of 82.8 and 81.2%, respectively, for the detection of malignancy. US accuracy was 81.9%. The presence of pleural/diaphragmatic nodules, pleural/diaphragmatic thickness >10 mm, and a swirling sign was significantly different between both groups (p < 0.001). Lung air bronchogram sign and a septated US pattern were more common in non-MPE patients (p < 0.01). The existence of nodularity and the absence of air bronchograms were more likely to indicate malignancy (OR 29.0, 95% CI 7.65-110.08 and OR 10.4, 95% CI 1.65-65.752, respectively). Conclusions: In the presence of an undiagnosed pleural effusion, US morphological characteristics can aid in differentiating MPE from non-MPE. Pleural/diaphragmatic nodularity was the most relevant feature although no finding was pathognomonic of MPE.

show abstract

Section: Discussionsupporting

confidence: 78%

The Diagnostic Value of Transthoracic Ultrasonographic Features in Predicting Malignancy in Undiagnosed Pleural Effusions: A Prospective Observational Study

Bugalho

Ferreira

Dias³

et al. 2014

Respiration

View full text Add to dashboard Cite

show abstract

“…Previous studies in the field have reported on thoracic ultrasound in patients with pleural effusion (7-9, 14, 15), most demonstrating that tuberculosis causes a complex septated pattern more often than malignancy. For example, in a study of 73 patients with lung cancer and 93 with tuberculosis-related pleural effusion, a complex septated pattern was present in 4% and 47% of patients respectively, and a complex nonseptated pattern was present in 85% and 41% [7]. Nonetheless, most studies have been retrospective, limited by sample size, and did not use a gold standard approach for evaluation of pleural disease -histological evaluation of samples obtained by pleural needle biopsy or thoracoscopy.…”

Section: Discussionmentioning

confidence: 92%

“…Previous studies have shown that a complex septated pattern is suggestive of tuberculosis. However, those studies were either retrospective, included a limited number of patients, did not use a gold standard method such as histological evaluation or bacterial cultures for diagnosis, or reported only on patients with tuberculosis [7][8][9][10]. To our knowledge there are no published studies on assessment of thoracic ultrasound in unselected patients with pleural effusion of unknown origin.…”

Section: Introductionmentioning

confidence: 97%

Sonographic evaluation of unexplained pleural exudate: a prospective case series

Marčun

Šustić

2009

Wien Klin Wochenschr

View full text Add to dashboard Cite

show abstract

“…According to the internal echogenicity, pleural effusions have been categorised into four types: anechoic, homogenously echogenic, complex non-septated and complex septated. Effusions induced by TB were subclassified as anechoic, complex non-septated or complex septated since the homogenously echogenic type had not been observed among patients with TP 8. Effusion was defined as anechogenic if totally echo-free spaces were present between the visceral and parietal pleura (fig 1A).…”

Section: Methodsmentioning

confidence: 99%

Sonographic septation: a predictor of sequelae of tuberculous pleurisy after treatment

Lai

Weng

et al. 2009

Thorax

View full text Add to dashboard Cite

Background: Findings in the literature have been quite conflicting with respect to predicting residual pleural thickening (RPT) in tuberculous pleurisy (TP). The aim of this study was to determine which sonographic feature of TP might help in predicting the development of RPT. Methods: Eighty-seven patients with TP were enrolled prospectively. The initial sonographic features were classified as anechoic, homogenously echogenic, complex non-septated and complex septated. The RPT level was measured 12 months after the start of antituberculosis (TB) treatment. Spirometry was performed 6 and 12 months after the start of anti-TB treatment. Results: A higher odds of an RPT level .10 mm was found in patients with positive TB bacillus culture in pleural fluid (OR, 20.9; 95% CI, 2.2 to 198.0) and a complex septated sonographic pattern (OR, 145.0; 95% CI, 22.3 to 942.3). A complex septated sonographic pattern can predict RPT with a sensitivity of 80%, specificity of 96%, positive predictive value of 84% and negative predictive value of 94%. Patients with an RPT level .10 mm had a lower forced vital capacity than those without (75.4% (9.2%) predicted vs 83.2% (9.5%) predicted, p,0.01) Conclusion: A complex septated sonographic pattern is a useful sign to predict an RPT level .10 mm 1 year after the start of anti-TB treatment. An RPT level .10 mm is associated with a high probability of decreased lung volumes. Therefore, the initial sonographic feature is beneficial in predicting the sequelae of TP after treatment.The incidence rate of tuberculosis (TB) in Taiwan was 67.38 per 100 000 people in 2006.1 Although prevalence and mortality rates have decreased with time owing to effective drug treatment, this infectious disease remains a serious public health issue because of its detrimental complications. Tuberculous pleurisy (TP) is one of the manifestations of TB and is present in 10% of all causes of TB in Taiwan. 2 Although updated therapeutic regimens can effectively control this infectious disease and minimise its sequelae, residual pleural thickening (RPT) has been found in about half of the patients. [3][4][5] We have previously shown that approximately 26% of patients with TP after treatment are complicated with RPT levels .10 mm.6 RPT may result in a decreased lung volume and then have important clinical repercussions. It is therefore important to identify the clinical and functional impairment resulting from RPT in patients with TP receiving anti-TB treatment. Thus, the aim of this prospective study was to investigate if sonographic features can serve as a predictor of patient outcomes 12 months after the start of anti-TB drug treatment. To the best of our knowledge, limited studies have been published regarding the evaluation of RPT and the associated impairment in treated TP patients by using the initial songraphic parameters.

show abstract

Sonographic Septation in Lymphocyte-Rich Exudative Pleural Effusions

Cited by 25 publications

References 18 publications

The Diagnostic Value of Transthoracic Ultrasonographic Features in Predicting Malignancy in Undiagnosed Pleural Effusions: A Prospective Observational Study

The Diagnostic Value of Transthoracic Ultrasonographic Features in Predicting Malignancy in Undiagnosed Pleural Effusions: A Prospective Observational Study

Sonographic evaluation of unexplained pleural exudate: a prospective case series

Sonographic septation: a predictor of sequelae of tuberculous pleurisy after treatment

Contact Info

Product

Resources

About