The use of multi-detector computed tomography and ultrasonography for evaluation of pleural lesions

Abstract

Background and objective: Multidetector CT (MDCT) and ultrasonography (US) are of increasing importance for assessment of many pulmonary disorders. Our aim was to evaluate their role in diagnosis of pleural diseases.Methods: Patients from Tanta University Hospital who were suspected to have pleural lesions (symptoms, signs and/or suggestive chest X-ray) during one year period were enrolled in the study. US and MDCT were done for all of them, then data were reported and analyzed.Results: Seventy-one patients were included, sixty of them had evident pleural lesions. Chest pain was the commonest presenting symptom. Malignancy represented 36.7% of pleural lesions, a percentage similar to lesions due to infection etiology. Free pleural effusions were the most common pleural lesions followed by pleural thickening. US was diagnostic in 72% of pleural lesions detectable by MDCT. Multiplanar reconstruction (MPR) images had an additional value than axial images in 39% of pleural lesions, mostly in cases of pleural thickening, free pleural effusion, pleural masses, encysted pleural effusions and pleural plaques. On the other hand, the MPR images had the same value as axial images in empyema and pneumothorax cases.Conclusion: MDCT is an important noninvasive imaging tool in accurate detection and characterization of pleural lesions with complementary MPR images that solve many diagnostic problems. Ultrasonography is a safer alternative but with less diagnostic value.

Efficacy of ultrasonography in diagnosis of pleural effusion

“…Previous studies also reported that ultrasound detected 70% of cases pleural thickness but chest radiography detected only 10% [17] . Helala et al study showed that ultrasound detects pleural thickness more accurate than chest radiography [18] .…”

Laboratory and Radiological Imaging in Evaluating Cases with Pleural Effusion

“…On the other hand, Bediwy et al, (7) stated that in TUS was less sensitive than CT chest in detecting pleural thickening and pleural nodules or masses. Also Raj et al, (9) who stated that CT chest allows detailed evaluation of the pleura and differentiation of benign from malignant pleural disease and also adequate enhancement of the pleura enables differentiation of the thickened pleura from adjacent effusion or aerated or collapsed lung.…”

“…Bediwy et al, (7) stated that in TUS diagnosed 83.3% of free pleural effusion lesions, 60% of encysted pleural effusion lesions with diagnosing all empyema lesions, but less sensitive in detecting pleural thickening and pleural nodules or masses.…”

Validation of Radiological Imaging in Evaluating Cases with Pleural Effusion

“…On the other hand, Bediwy et al, (12) stated that in TUS was less sensitive than CT chest in detecting pleural thickening and pleural nodules or masses. Also Raj et al, (16) who stated that CT chest allows detailed evaluation of the pleura and differentiation of benign from malignant pleural disease and also adequate enhancement of the pleura enables differentiation of the thickened pleura from adjacent effusion or aerated or collapsed lung.…”

“…Bediwy et al, (12) stated that in TUS diagnosed 83.3% of free pleural effusion lesions, 60% of encysted pleural effusion lesions with diagnosing all empyema lesions, but less sensitive in detecting pleural thickening and pleural nodules or masses. Sikora et al, (13) also reported that transthoracic US serves as a more accurate imaging tool than chest radiography in the diagnosis of pleural effusions and allows discrimination of pleural effusions from other lung pathology which may appear similar on a chest X-ray.…”