Disorders of the Pleura |

Chest Ultrasound Versus CT for Imaging Assessment Prior to Medical Thoracoscopy FREE TO VIEW

Magdy Khalil, MD; Haytham Samy, MD; Hanan Hosny, MD; Emad Edward, MD; Ehab Thabet, MD; Wael Emara, MD; Ahmad Soliman, MD; Hanaa Fayez, MD
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Ain Shams University, Cairo, Egypt

Chest. 2014;145(3_MeetingAbstracts):280A. doi:10.1378/chest.1782980
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SESSION TITLE: Pleural Disease/Pleural Effusion Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: The aim of this work was to assess the concordance between chest ultrasound (US) and chest CT findings prior to medical thoracoscopy (MT), the impact of the findings on the conduct and outcome of MT and whether US alone or in combination with chest X-ray (CXR) can be sufficient for imaging assessment before the procedure.

METHODS: The study was conducted prospectively on 52 patients referred for MT during 2012 (28 males and 24 females; 56±14 years old). All patients received CXR, chest US and chest CT prior to the procedure. Images were evaluated for location and size of effusion, loculation, fibrin strands, pleural masses, nodules and thickening and lung parenchymal lesions. Imaging findings were correlated with thoracoscopic findings.

RESULTS: US findings were discordant with CT findings regarding consistency, septation and loculation of effusion in 24/52 patients, with US detecting the findings in 24/24 patients (thick fibrous septation with multiloculations in 17/24 and few fibrin strands in 7/24). None of these findings was detectable in CT (P< 0.001). The US findings prevented MT in12/52 cases, and led to prolongation of MT in 6/40 and to change in port of entry in 2/40 and they were associated with failure to achieve post-MT full lung expansion in7/40 cases. US findings were consistent with MT findings in all cases who underwent the procedure except for one case with morbid obesity and thick septation undetectable in US and CT. US findings were concordant with CT findings regarding site and size of effusion, pleural masses, nodules and thickening, and concealed lung pathology with US missing tiny nodules in 10/52, consolidation in 2/52, mediastinal lymphadenopathy in 6/52, and mediastinal shift in 42/52 cases. CXR could identify mediastinal shift but none of other CT findings missed by US. None of US-missed abnormalities directly altered MT management.

CONCLUSIONS: US identifies more explicitly the imaging information relevant to MT compared to chest CT.

CLINICAL IMPLICATIONS: Pre-MT imaging workup can be limited to CXR and US, reserving chest CT for cases in which US is technically unrevealing. The omission of pre-MT routine CT scanning will reduce costs and potential risk of exposure to radiation.

DISCLOSURE: The following authors have nothing to disclose: Magdy Khalil, Haytham Samy, Hanan Hosny, Emad Edward, Ehab Thabet, Wael Emara, Ahmad Soliman, Hanaa Fayez

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