0
Clinical Investigations: CARDIOLOGY |

Bedside Diagnosis and Follow-up of Patients With Pleural Effusion by a Hand-Carried Ultrasound Device Early After Cardiac Surgery*

Mara Piccoli, MD; Paolo Trambaiolo, MD; Alessandro Salustri, MD, PhD; Elena Cerquetani, MD; Alfredo Posteraro, MD; Guglielmo Pastena, MD; Elisabetta Amici, MD; Federica Papetti, MD; Edoardo Marincola, MD; Salvatore La Carruba, MD; Giancarlo Gambelli, MD
Author and Funding Information

*From the Departments of Cardiology (Drs. Piccoli, Trambaiolo, Salustri, Cerquetani, Posteraro, Pastena, Amici, Papetti, La Carruba, and Gambelli) and Radiology (Dr. Marincola), Presidio Ospedaliero Integrato Portuense, Rome, Italy.

Correspondence to: Alessandro Salustri, MD, PhD, Cardiology Department, Presidio Ospedaliero Integrato Portuense, Via dei Badoer, 5, 00148 Rome, Italy; e-mail: salustri.a@tiscali.it



Chest. 2005;128(5):3413-3420. doi:10.1378/chest.128.5.3413
Text Size: A A A
Published online

Objectives: The aim of this study was to assess the potential value of hand-carried ultrasound (HCU) devices in the diagnosis and follow-up of patients with pleural effusion (PE) after cardiac surgery.

Methods: Seventy consecutive patients were evaluated at bedside early after cardiac surgery, in the upright sitting position, using an HCU device on hospital admission and every 3 days until hospital discharge. The posterior chest wall was scanned along the paravertebral, scapular, and posterior axillary lines. For each hemithorax, an effusion index was derived as the sum of the intercostal spaces between the lower and upper limits of the PE along the lines of scanning, divided by 3. A standard chest radiograph was performed in all patients on hospital admission and at hospital discharge, and was qualitatively scored (0, absent; 1, small; 2, large PE). The findings of the HCU device and radiograph were compared using κ statistics and the Kruskal-Wallis test.

Results: A chest ultrasound was feasible in all patients (mean [± SD] time, 5 ± 2 min). Compared with the chest ultrasound, a physical examination showed a sensitivity of 69% and a specificity of 77%. On hospital admission, the HCU device detected a PE in 72 of 140 hemithoraxes. Agreement with the finding of the radiograph was 76% (κ = 0.52). In 15 hemithoraxes, the HCU device revealed a PE that had not been diagnosed using the radiograph. Conversely, in 18 hemithoraxes a PE that had been diagnosed with a radiograph was not confirmed by the HCU device. The correlation between ultrasound and radiographic scores was statistically significant (p < 0.001). At hospital discharge, a PE was present in 31 of 140 hemithoraxes according to the findings of the HCU device, and in 38 of 140 hemithoraxes according to the findings of the radiograph (agreement, 78%; κ = 0.44).

Conclusions: In patients early after cardiac surgery, HCU devices allow rapid PE detection and improve the clinical diagnosis. Compared to a radiograph, this method offers the unique advantage of the bedside evaluation of patients without the need for radiation exposure.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
A Seedless Grape in the Heart. Circulation 2015;132(15):e189-90.
Tamponade Relief by Active Clearance of Chest Tubes. Ann Thorac Surg 2016;101(3):1159-63.
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543