الفهرس 
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Abstract
Summary
This study was conducted prospectively on 53 patients with unexplained pleural effusion at Abbassia
chest hospital during the period from December 2013 to
August 2014. This study included 33 males & 20 females,
with a mean±SD age 56.83 ± 11.47 year.
Chest ultrasound was done to every patient prior to
the procedure ( thoracoscope, open pleural biopsy or
Abrams needle) to detect the sonographic findings as
regard pleural effusion, loculation, fibrin strands, and
underlying lung lesions.
Also chest CT was done to every patient with
exudative pleural effusion prior to the procedure to
examine the concordance and discordance between it and
chest ultrasound 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:
Our study showd that there were highly significant
differences between malignant and non-malignant groups
as regards the nature of effusion; anechoic pattern was
associated with transudative effusion (100%), complex
septated pattern was associated with malignant effusion
(47.6%) and complex non septated pattern was associated
with non malignant effusion (45%) but there were no any
nature limited to any type.
In the present study, US altered patient diagnostic
process either thorough specifying a definite diagnosis,
adding new findings, confirmed a provisional diagnosis or
excluding differential diagnosis in an appreciable number
of patients. For example, replacing medical thoracoscopy
with open pleural biopsy due to presence of thick fibrous
septation and multiloculations.
Our study showed that pleural thickening and
nodularities were highly significantly associated with
malignant effusion (61.9% and 66.7%).
There were high variability between size and type of
effusion. In malignant effusion there were 16/21 (75%
massive effusion, 6/21 moderate effusion (29%) and 0/21
(0%) mild effusions.In non malignant effusion there were
7/32 (22%) massive effusion,16/32 (50%) moderate
effusion and 11/32 (34%) mild effusion.
The results of our study showed that there is
concordance between chest ultrasound and chest CT in
detection of 53/53 patients (100%) with pleural effusion,
1/1 patient (100%) with underlying mass, 14/14 patients
(100%) with pleural thickening more than 1 cm with
diaphragmatic pleural nodules.
The results of this study showed that chest CT was
unable to detect internal echogenicity of pleural effusion as
compared with chest ultrasound, which was able to detect
four sonographic patterns of internal echogenicity of
pleural effusion. Pleural effusion was anechoic in 15/53
patients, complex non-septated in 18/53 patients, complex
septated in 19/53 patients, and homogeneously echogenic
in 1/53 patient. The homogenously echogenic pattern was
seen in hemorrhagic effusion.
The results of this study showed that chest ultrasound
was superior to chest CT in detection of 19/19 patients
(100%) with fibrin strands and multiloculation. 12/19
patients showed thick fibrous septation and multiloculation
whereas 7/19 cases showed few fibrin strands. These findings were detected by ultrasound consistent with the
operative findings but not detected by chest CT in any of
them.
Computed tomography is still considered the gold
standard for detection of pleural effusions. In addition, it
enables evaluation of the pleural space, allows accurate and
detailed evaluation of the thoracic wall, lung parenchyma,
and mediastinum.
Ultrasound had the best sensitivity and specificity
and other test parameters in diagnosing pleural effusion as
compared to chest X-ray. Ultrasound had a significant
better pleural effusion sensitivity, specificity, PPV, NPV,
and accuracy than those of X-ray.