الفهرس 
Chest Ultrasonography & Chest CTOnly 14 pages are availabe for public view
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Abstract
This study was conducted prospectively on 52 patients with unexplained exudative pleural effusion referred for medical thoracoscopy at Abbassia chest hospital during the period from January 2012 to December 2012. This study included 28 males & 24 females, with a mean±SD age 56 ± 14.2 year.
Chest ultrasound and chest CT were done to every patient prior to medical thoracoscopy to examine the concordance and discordance between both of them as regard pleural effusion, loculation, fibrin strands, and underlying lung lesions. Imaging findings were correlated with operative findings.
from the present study, the following results were obtained:
- There was concordance between chest ultrasound and chest CT in detection of pleural effusion, lung consolidation in 5/7 patients (71.4%), lung mass, lung collapse, pleural thickening, diaphragmatic pleural nodules in 3/16 patients (18.8%), pleural mass as well as pneumothorax.
- The ultrasound was very sensitive in detecting internal components of pleural effusion including fibrin strands, which can not be detected by computed tomography. TUS missed fibrous septation and multiloculation in only 1/52 patients due to morbid obesity that degraded the image quality.
- Chest US findings of thick fibrous septation and multiloculation, resulted in replacing medical thoracoscopy with open pleural biopsy by (66.7%) of thoracoscopists in 12 out of the 52 cases, so only 40 cases had undergone medical thoracoscopy.
- 33.3% of thoracoscopists were unconvinced with replacing medical thoracoscopy with open pleural biopsy in cases with thick fibrous adhesions and multiloculation on the assumption that they can dissect adhesions and breakdown locules during the procedure.
- TUS could not detect parietal pleural nodules (costal and mediastinal) as they were small in size, pulmonary nodules, loculated effusion, ground glass opacification, mediastinal lymphadenopathy, mediastinal shift to contralateral side, astherosclerosed aorta and bony abnormalities which were detected by chest CT.
- Comparison between chest computed tomography and chest X-ray findings in patients with abnormalities confirmed by chest computed tomography and missed by chest ultrasound showed that the CXR had low sensitivity in elucidating the findings missed with chest ultrasound, except mediastinal shift.
- The TUS findings affected time of thoracoscopic procedures in 5/40 patients (12.5%) where it is prolonged due to thick fibrous adhesions between the lung and chest wall.
- By end of the study, 33.3% of thoracoscopists became convinced with a combination of CXR and TUS as an alternative to chest CT prior to medical thoracoscopy.