Chest
Original Research Pulmonary ProceduresNovel Use of Pleural Ultrasound Can Identify Malignant Entrapped Lung Prior to Effusion Drainage
Section snippets
Study Design
This was a prospective multicenter cohort study, conducted between March 2012 and October 2013. The study was approved by the Human Research Ethics Committee at Royal Brisbane and Women's Hospital (Queensland, Australia) (approval number: HREC/11/QRBW/452).
Consenting patients undergoing drainage of at least 500 mL for suspected malignant pleural effusion were recruited. The primary outcome was the ability of predrainage M mode and STI to identify entrapped lung as defined by postdrainage
Results
Eighty-three consecutive patients were recruited for the study; two were excluded as they were designated as not scorable on postdrainage radiology (Fig 2). Fifty-one were men, and the mean age was 66 years (62-70 years) (95% CI). The final diagnosis was pleural malignancy (59%), parapneumonic (8%), heart failure (4%), and other (29%). Mean pleural drainage volume was 1,351 mL (1,194-1,509 mL) (95% CI).
There were 34 patients in the development set and 47 in the validation set. The number of
Discussion
This study documents a novel approach to the identification of malignant entrapped lung, using preprocedure ultrasonography. M mode and STI strain analysis of the atelectatic lung gave very favorable results for diagnostic parameters, and measurements demonstrated a high level of reliability. Although some features can suggest the presence of entrapped lung (thickening of the visceral pleura at ultrasound, elevated PEL, or basilar pneumothorax on postdrainage imaging), it is often very
Acknowledgments
Author contributions:M. R. S. takes responsibility for the accuracy of data and manuscript content. M. R. S. contributed to study design and patient recruitment, assisted with ultrasound scans, analyzed data, and wrote the manuscript; A. K. C. L. contributed by performing ultrasound scans; A. C. T. N. contributed to the analysis of the ultrasound images; F. B. contributed to postdrainage radiology scoring; W. Y. S. W. contributed to the analysis of ultrasound images for reliability testing; D.
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Funding/Support:Dr Salamonsen was supported by research scholarships from the National Health and Medical Research Council and the RBWH Foundation.
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originally published Online First July 10, 2014.