PURPOSE: The purpose of this study was to evaluate the incidence and the size of pulmonary emboli-associated pleural effusions.
METHODS: This is a retrospective analysis of 45 patients with the diagnosis of pulmonary embolism for over a 3 year period time. Computed tomography pulmonary angiography (CTPA) was used for the diagnosis of pulmonary embolism. Chest x-ray (CXR) was also performed for detection of pleural effusion.
RESULTS: Pleural effusion was present on CXR in twenty six (57%) patients. In fifteen (57%) of them it was right-sided, in five (19%) left-sided while six (24%) patients presented with bilateral pleural effusion. Twenty two (84%) effusions occupied less than 10% of the hemithorax, four (16%) 10–40%, and none occupied more than 40% of the hemithorax. In three (12%) cases, pleural effusion was not evident in CXR and was diagnosed on chest CT. Only four (16%) patients underwent thoracentecis. According to Light's criteria, all fluids were exudates with equal incidence of neutrophilic or lymhocytic predominance.
CONCLUSION: Pleural effusions were present in more than half of the patients with pulmonary embolism. The majority of them were small (<10% of the hemithorax). Pleural fluid findings were not diagnostically helpful.
CLINICAL IMPLICATIONS: Although chest x-ray cannot be used to rule in or rule out pulmonary embolism, the nondiagnosed small pleural effusions should alarm clinicians for the possibility of thromboembolic disease. On the other hand, large pleural effusions, especially if occupying more than half of the hemithorax, make the diagnosis of pulmonary embolism unlikely.
DISCLOSURE: Vasileios Skouras, No Financial Disclosure Information; No Product/Research Disclosure Information