Aim: Pleural effusion in most cases requires thoracocentesis or drainage for diagnostic or therapeutic purpose. The purpose of this study was to evaluate the value of chest sonography in the diagnosis and management of patients with pleural effusions.
Methods: Four hundred sixty-five patients with chest opacities underwent chest sonography during two years period. This study included of 304 patients with pleural effusions. US characteristics of effusions as echo structure, pleural thickening and nodulations and diaphragm motions were analyzed. Regarding the US finding, thoracocentesis or drainage was performed. The procedure was performed mostly without direct US guidance in 'free-hand' technique.
Results: Study included 224 male and 80 female patients. Pleural effusion was nearly at the same frequency on both sides (142 right vs. 131 left) and in 31 patient, bilateral pleural effusion was present. Two hundred twenty-three patients had loculated pleural effusion. Pleural nodulations were detected in 13, and lung consolidation in 11 patients. Most frequent echo structure of loculated effusions was complex septated (120), followed by hypoechoic (77). Thickened pleura was detected in 89% of these patients. Diaphragm motion was impaired in 230 cases: diaphragm movement significantly decreased in 167 patients, and in 63 cases no active movement was detected. Regarding the US finding, thoracocentesis or drainage was performed in 196 cases. The 'free-hand' technique without direct US guidance was performed in 149 pts with loculated and in 31 with free fluid effusion. Thoracocentesis or drainage under direct US guidance was done in 16 patients (9 with loculated and 7 with small free fluid collection). The success thoracocentesis or drainage rate without US guidance was 86.1% and under US guidance was 87.5%.
Conclusion: US is useful in diagnosis of pleural disease. It is method of choice to assist with thoracocentesis and drainage of effusions with a high rate of success.
