Detection of Pleural

Effusion with
Ultrasound
Nita Corry Agustine
 The pleural effusion ultrasound
examination analyze the possible types
pleural effusion.
To detect the presence of minimal pleural
effusion ultrasound examination is more
sensitive (20 cc) than the lateral decubitus
position image examination (>200 cc).
Ultrasound can also be used to estimate
the amount of pleural fluid.
Accuracy in detecting pleural effusion with chest X-
rays 47%.
(Prina , E, et all. J Bras Pneumol. 2014;40(1):1-5)
Diagnosis of the Nature of
Pleural Effusion
Transudat Eksudat
Anechoic
Regularly echoic
contain various amounts
of echoic particles
A transudate yields
(plankton sign, fibrin
completely anechoic strands, hematocrit sign),
effusion. homogenous echoes
Septations
Hemothorax, purulent
pleurisy
How to Perform Thoracic
Ultrasonography
The identification of
adjacent structures:
chest wall,
hemidiaphragm (over
the liver or spleen),
and visceral pleural
surface.
The distinction
between transudative
and exudative pleural
effusions.
Volume Estimation
Pleural effusion volumetry in
sitting patients :
1. Useful parameters include
the maximal extent of
effusion
2. The thickness of the lateral
mantle of the effusion
3. The distance between the
basal atelectasis and the
chest wall
4. The basal distance between
lung and diaphragm
5. The subpulmonary effusion
height
6. The height of the basal
atelectasis

(From Goecke and Schwerk

1990)
Volume Estimation
Volume Estimation
Normal Chest Wall
No fluid between liver and lung,
thus excluding a free-floating
Viceral Pleural Thickening
Anechoic Pleural
Small dorsal pleural effusion between spine
and diaphragm in a transhepatic view.
Small effusion in the costophrenic angle.
Honeycomb-like appearance
of a postinflammatory
Pleural empyema with
echogenic content
and considerable
septation.
Plankton Sign on Voluminous left
hemothorax.
On this longitudinal subcostal scan, the left
kidney (K), the spleen (S), the
hemidiaphragm, then an area (M) evoking
Large pleural effusion with evidence of
diaphragmatic pleural metastasis.
Longitudinal scan midaxillary on left.
Pleural effusion with inverted
diaphragm.