Source: Annual Congress 2010 - Novel approach in diagnosis and treatment of pleural effusions
Disease area: Pulmonary vascular diseases, Thoracic oncology

Abstract

Pulmonary emboli (PEs) are considered a common cause of pleural effusions partly because observational series demonstrate that they are noted on CT pulmonary angiogram (CTPA) in 50% of patients with PE. These effusions are usually too small to be detected on chest X-ray or clinically. Aims: To establish the incidence of PEs in patients with new, undiagnosed unilateral pleural effusions using a novel CT scan protocol combining CTPA with a conventional pleural contrast staging CT as a single scan. Methods:Consecutive patients with a new undiagnosed unilateral pleural effusion, requiring investigation with a pleural CT scan who were referred to a UK teaching hospital were included. Trial scans were reported independently by 2 radiologists. Patients were followed up to histological diagnosis or for 12 months.Results: 82 patients underwent trial CT, 34% inpatients, 66% outpatients, median age 73(42-96).Pleural effusions were small 15%, moderate 51% and large 34%. Pulmonary emboli were diagnosed in 3/82 (3.7%). Pulmonary artery opacification was good in 71/82 (87%). Visualisation of the pleura was good in 79/82(96%) with pleural thickening detected and characterised in 67/82(81%). The diagnoses was malignant 47/82, pleural infection 7/82, cardiac cause 12/82, benign 14/82 and unconfirmed 2/82.Conclusion: PEs are an uncommon cause of symptomatic undiagnosed pleural effusions. When exclusion of PEs is clinically indicated in a patient undergoing a pleural contrast CT scan, our protocol avoids the need for 2 scans without loss of diagnostic accuracy in either the arterial or pleural contrast phase.

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Citations should be made in the following way:
C. E. Hooper, I. J. Laurence, J. E. Harvey, M. Darby, N. A. Maskell (Bristol, United Kingdom). Pulmonary emboli in patients with undiagnosed pleural effusions – Clinical utility of a novel CT scan protocol. Eur Respir J 2010; 36: Suppl. 54, 230

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