Procedures: Procedures: Pleura |

Peural Effusion Volume Estimation by Thoracic Ultrasound FREE TO VIEW

Maged Hassan, MBBCh; Rana Rizk, MBBCh
Author and Funding Information

Faculty of Medicine, Alexandria University, Alexandria, Egypt

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A439. doi:10.1016/j.chest.2016.02.457
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Published online

SESSION TITLE: Procedures: Pleura

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Pleural effusion size estimation can be helpful for guiding the necessity for drainage or in assessing response to therapy in cases of pleural infection or fluid overload. Ultrasonography (US) is a non-invasive and cheap means. Available equations for sonographic effusion volumetry are either rough, sophisticated, or inaccurate. This study attempted to derive an accurate formula for pleural fluid estimation that relies on easily measured parameters.

METHODS: A 2-5 MHz curvilinear probe was used to assess cases with pleural effusion. Cases with evidence of encystment/loculation or diaphragmatic pathology were excluded. Assessment was done at the posterior axillary line in erect patients. The probed was moved in the cephalo-caudal orientation to capture the collapsed lower lobe above the diaphragm. Two measurements were taken at end-expiration: the distance between lung base and mid-diaphragm (D) and that between lung and chest wall (C). The probe was then rotated 90 degrees marking the lower and higher most points of effusion to determine its height (H). Only cases undergoing full drainage of effusion were included and this was confirmed by post-tapping US. Volume of aspirate (V) was then recorded.

RESULTS: 38 cases were included; 24 with right and 14 with left effusion. Common etiologies included heart failure, malignancy and post-cardiac surgery. 34 patients were spontaneously breathing and 4 on mechanical ventilation. Median volume aspirated was 1310 ml (min 330, max 2500). Values of C and D in mm and H and (H+D) in cm were separately entered into linear regression in attempt to derive a predictive formula for V. Strength of association as measured by R2 in ascending order for C, D, H and (H+D) was: 0.39, 0.66, 0.73 and 0.81. The regression equation for the most 2 predictive parameters were as follows: V = H × 106.7 + 65 (95% CI for beta coefficient 83-130). V = (H+D) × 82.2 - 51 (95% CI for beta coefficient 67-97). Interestingly, when the mean coefficient for H was compared between right (119±27) and left (97±9) sides, there was statistically significant difference (p 0.01).

CONCLUSIONS: In the seated patient, using the either US-measured distance between lung and diaphragm or lung and chest wall is less accurate than using the vertical height of the effusion. The best predictor is the sum of the vertical height and lung-to-diaphragm distance. Accuracy of estimation may differ according to side of effusion.

CLINICAL IMPLICATIONS: Pleural fluid height can be used to predict its volume in a fairly accurate way.

DISCLOSURE: The following authors have nothing to disclose: Maged Hassan, Rana Rizk

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