Disorders of the Pleura |

The Accuracy of a Pre- and Postthoracentesis Diagnosis of a Pleural Effusion FREE TO VIEW

Kenneth Walters, MD; Carlos Kummerfeldt, MD; Matthew Divietro, MD; Jennings Nestor, MD; John Huggins, MD; Steven Sahn, MD; Peter Doelken, MD
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Medical University of South Carolina, Charleston, SC

Chest. 2013;144(4_MeetingAbstracts):512A. doi:10.1378/chest.1704977
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SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: It is unknown the accuracy of the clinical history alone in rendering an accurate diagnosis of a pleural effusion. The aim of our study was to determine the accuracy of a pre- and post-thoracentesis diagnosis in establishing the etiology of the effusion, comparing a pleural disease expert (main focus of research in pleural disease) and a non-expert pulmonologist.

METHODS: An electronic database records all thoracenteses performed in the Pleural Procedural suite at the Medical University of South Carolina and requires the attending physician to provide a pre and post-procedural diagnosis of the effusion. Pleural manometry is used when clinically appropriate. After the pleural fluid analysis is complete, a final diagnosis is determined. The first 25 thoracenteses were evaluated. We compared the accuracy of the pre- and post-thoracentesis diagnosis with that of the final diagnosis to determine the overall accuracy and identify if differences exist between a pleural expert and a non-expert.

RESULTS: Of 25 results, 14 were performed by non-experts with the remaining 11 by pleural experts. After pleural fluid analysis, a final diagnosis was unable to be determined in two cases, both performed by non-experts. There was also a preponderance of malignancy in the group, accounting for 11 of the 25. Overall predictive accuracy was 19 of 25 (76.0%). Pleural experts correctly identified the diagnosis in 10 of 11 procedures (90.9%). Non-experts were correct in 9 of 14 procedures (64.3%). Bedside fluid evaluation and manometry (used in 7 cases) added a post-procedural secondary diagnosis (lung entrapment, trapped lung) in 2 of 25 cases.

CONCLUSIONS: Pleural experts are able to generate an accurate diagnosis in greater than 90% of pleural effusions, based on clinical history alone. The post-thoracentesis diagnosis was altered in 2 of the 25 cases, both secondary to pleural manometry rather than fluid appearance.

CLINICAL IMPLICATIONS: A majority of pleural effusion cases can be reliably diagnosed prior to an invasive evaluation, especially when a pleural-expert pulmonologist is involved.

DISCLOSURE: The following authors have nothing to disclose: Kenneth Walters, Carlos Kummerfeldt, Matthew Divietro, Jennings Nestor, John Huggins, Steven Sahn, Peter Doelken

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