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Original Research: Pulmonary Procedures |

Novel Use of Pleural Ultrasound Can Identify Malignant Entrapped Lung Prior to Effusion DrainageIdentification of Trapped Lung With Ultrasound

Matthew R. Salamonsen, MBBS; Ada K. C. Lo, MAppSc; Arnold C. T. Ng, MBBS, PhD; Farzad Bashirzadeh, MBBS; William Y. S. Wang, MBBS; David I. K. Fielding, MD
Author and Funding Information

From the Department of Thoracic Medicine (Drs Salamonsen, Bashirzadeh, and Fielding) and Department of Cardiology (Ms Lo), Royal Brisbane and Women’s Hospital; and Department of Cardiology (Drs Ng and Wang), The Princess Alexandra Hospital, Brisbane, QLD, Australia.

CORRESPONDENCE TO: Matthew R. Salamonsen, MBBS, Department of Thoracic Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Herston 4029, QLD, Australia; e-mail: mattsalamonsen@gmail.com


FUNDING/SUPPORT: Dr Salamonsen was supported by research scholarships from the National Health and Medical Research Council and the RBWH Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1286-1293. doi:10.1378/chest.13-2876
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BACKGROUND:  The presence of entrapped lung changes the appropriate management of malignant pleural effusion from pleurodesis to insertion of an indwelling pleural catheter. No methods currently exist to identify entrapped lung prior to effusion drainage. Our objectives were to develop a method to identify entrapped lung using tissue movement and deformation (strain) analysis with ultrasonography and compare it to the existing technique of pleural elastance (PEL).

METHODS:  Prior to drainage, 81 patients with suspected malignant pleural effusion underwent thoracic ultrasound using an echocardiogram machine. Images of the atelectatic lower lobe were acquired during breath hold, allowing motion and strain related to the cardiac impulse to be analyzed using motion mode (M mode) and speckle-tracking imaging, respectively. PEL was measured during effusion drainage. The gold-standard diagnosis of entrapped lung was the consensus opinion of two interventional pulmonologists according to postdrainage imaging. Participants were randomly divided into development and validation sets.

RESULTS:  Both total movement and strain were significantly reduced in entrapped lung. Using data from the development set, the area under the receiver-operating curves for the diagnosis of entrapped lung was 0.86 (speckle tracking), 0.79 (M mode), and 0.69 (PEL). Using respective cutoffs of 6%, 1 mm, and 19 cm H2O on the validation set, the sensitivity/specificity was 71%/85% (speckle tracking), 50%/85% (M mode), and 40%/100% (PEL).

CONCLUSIONS:  This novel ultrasound technique can identify entrapped lung prior to effusion drainage, which could allow appropriate choice of definitive management (pleurodesis vs indwelling catheter), reducing the number of interventions required to treat malignant pleural effusion.

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