الفهرس 
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Abstract
Twenty-five patients with malignant pleural effusions and 25 patients with non-malignant pleural effusions were enrolled in our series. The underlying diseasesof non-malignant pleural effusion, included empyema (n = 9 [36%]), TB (n = 6 [24%]), parapneumonic (n = 6 [24%]), and pulmonary embolism (n = 4 [16%]). In malignant effusion, metastatic adenocarcinoma from other malignancies except lung cancer was the most common (n = 17 [68%]), mesothelioma (n = 6 [24%], and poorly differentiated non small cell, large cell carcinoma in one case for each type (n = 2 [8%]). In the assessment of the amount of pleural effusions, there were massive pleural effusions in most of malignant effusion n=18(72%), whereas moderate amount was found in 52% of non-malignant effusion (n=13). Regarding the lung cancer cell type, the most frequent was metastatic adenocarcinoma, followed by mesothelioma.
Sonographic Patterns Between malignant and non-malignant Pleural Effusions
Twenty-five malignant pleural effusions had the following sonographic appearances: an anechoic pattern in 28% (7/25), a complex nonseptated pattern in 60% (15/25), and a complex septated pattern in 12% (3/25). The 25 non-malignant pleural effusions had the sonographic appearances of an anechoic pattern in 16% (4/25), a complex nonseptated pattern in 32% (8/25), and a complex septated pattern in 52% (13/25). Apparently, a complex septated pattern in lymphocyte-rich pleural effusions is a useful diagnostic predictor for differentiating non-malignant from malignant (p=0.046). If we define the complex septated pattern of lymphocyte-rich pleural effusions as a predictor of non-malignant pleural effusions, we can achieve sensitivity, specificity, positive predictive value and negative predictive value of 52%, 88%, 81%, and 66, respectively. Interestingly, for the complex nonseptatedsonographic pattern of malignant-related lymphocyte-rich pleural effusions, the differentiation between malignant and non-malignant was also significant (p=0.002). However, the sensitivity, specificity, positive predictive value, and negative predictive value were only 60%, 68%, 65%, 63%, respectively.
The presence of pleural nodules was found in all cases of malignant pleural effusion with the highest specificity (100%). Pleural thickening was detected in both malignant (88%, 22/25) and non-malignant pleural effusion (52%, 13/25) but it was significantly higher in malignant effusion (p= 0.005) and could predict malignant effusion with higher values than non-malignant effusion.
In conclusion, the sonographic appearances of septations are often present in non-mlignant pleural effusions whereas absence of septations or the presence of pleural nodules and thickening are good predictors in malignant exudative pleural effusions. Transthoracic ultrasound is useful in differentiating malignant from non-malignant pleural exudates and may become an important step in the diagnostic pathway.