Sonographic Bedside Quantification of Pleural Effusion Compared to Computed Tomography Volumetry in ICU Patients

 

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Abstract

Objectives

To date, the reliability of ultrasound for the quantitative assessment of pleural effusion has been limited. In the following study, an easy and cost-effective bedside ultrasound method was developed and investigated for specific use in the intensive care unit (ICU).

Methods

22 patients (median age: 58.5 years, range: 37–88 years, 14 men and 8 women) with a total of 31 pleural effusions were examined in the ICU. The inclusion criterion was complete visualization of the effusion on chest computed tomography (CT). The ultrasound (US) examination was performed less than 6 h after the diagnostic CT scan. The pleural effusion volume was calculated volumetrically from the CT scan data. Within 4.58 +/- 2.87 h after the CT scan, all patients were re-examined with US in the ICU. The fluid crescent's thickness was measured between each intercostal space (ICS) with the patient in a supine position and a 30° inclination of the torso. The US measurements were compared to the calculated CT volumes using regression analysis, resulting in the following formula: V=13.330 x ICS6 (V=volume of the effusion [ml]; ICS6=sonographic measurement of the thickness of the liquid crescent [mm] in the sixth ICS).

Results

A significant correlation between the sonographically measured and the CT-calculated volumes was best observed for the sixth ICS (R2=0.589; ICC=0.7469 with p<0.0001 and a 95% CI of 0.5364–0.8705).

Conclusion

The sonographic assessment of pleural effusions in a supine position and a 30° inclination of the torso is feasible for the volumetric estimation of pleural effusion. This is especially true for ICU patients with severe primary diseases and orthopnea who are unable to sit upright or lie flat.

• References

• 1 Mathis G. Thoraxsonography–Part I: Chest wall and pleura. Ultrasound Med Biol 1997; 23: 1131-1139
  CrossrefPubMedGoogle Scholar
• 2 Pernice H, Braun B. Sonographische Differenzierung pulmonaler Verschattungen. Prax Klin Pneumol 1979; 33: 1132-1137
  PubMedGoogle Scholar
• 3 Matalon TA, Neiman HL, Mintzer RA. Noncardiac chest sonography. The state of the art. Chest 1983; 83: 675-678
  CrossrefPubMedGoogle Scholar
• 4 Rosenberg ER. Ultrasound in the assessment of pleural densities. Chest 1983; 84: 283-285
  CrossrefPubMedGoogle Scholar
• 5 Doust BD, Baum JK, Maklad NF. et al. Ultrasonic evaluation of pleural opacities. Radiology 1975; 114: 135-140
  CrossrefPubMedGoogle Scholar
• 6 Eibenberger KL, Dock WI, Ammann ME. et al. Quantification of pleural effusions: sonography versus radiography. Radiology 1994; 191: 681-884
  CrossrefPubMedGoogle Scholar
• 7 Lorenz J, Börner N, Nikolaus HP. [Sonographic volumetry of pleural effusions]. Ultraschall Med 1988; 9: 212-215
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Schmidt O, Simon S, Schmitt R. et al. Volumetrie von Pleuraergüssen bei multimorbiden, postoperativen Patienten einer operativen Intensivstation, Vergleich von Sonographie und Thoraxbettaufnahme. Zentralbl Chir 2000; 125: 375-379
  PubMedGoogle Scholar
• 9 Schwerk WB, Riester KP, Hess F. Real-Time- Ultraschalltomographie von Pleuraergüssen und pleuranahen intrathorakalen Raumforderungen. Respiration 1980; 39: 219-228
  CrossrefPubMedGoogle Scholar
• 10 Gryminski J, Krakowka P, Lypacewicz G. The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest 1976; 70: 33-37
  CrossrefPubMedGoogle Scholar
• 11 Balik M, Plasil P, Waldauf P. et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 2006; 32: 318-321
  CrossrefPubMedGoogle Scholar
• 12 Börner N, Kelbel C, Lorenz J, Weilemann LS, Meyer J. Sonographische Volumenbestimmung und Drainage von Pleuraergüssen. Ultraschall in Klinik und Praxis 1987; 2: 148-152
  PubMedGoogle Scholar
• 13 Moss AA, Friedman MA, Brito AC. Determination of liver, kidney, and spleen volumes by computed tomography: an experimental study in dogs. J Comput Assist Tomogr 1981; 5: 12-14
  CrossrefPubMedGoogle Scholar
• 14 Heymsfield SB, Fulenwider T, Nordlinger B. et al. Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography. Ann Intern Med 1979; 90: 185-187
  CrossrefPubMedGoogle Scholar
• 15 Fritschy P, Robotti G, Schneekloth G. et al. Measurement of liver volume by ultrasound and computed tomography. J Clin Ultrasound 1983; 11: 299-303
  CrossrefPubMedGoogle Scholar
• 16 Breiman RS, Beck JW, Korobkin M. et al. Volume determinations using computed tomography. AJR Am J Roentgenol 1982; 138: 329-333
  CrossrefPubMedGoogle Scholar
• 17 Brenner DE, Whitley NO, Houk TL. et al. Volume determinations in computed tomography. Jama 1982; 247: 1299-1302
  CrossrefPubMedGoogle Scholar
• 18 Lemke AJ, Hosten N, Neumann K. et al. CT-Volumetrie der Leber vor der Transplantation. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 1997; 166: 18-23
  PubMedGoogle Scholar
• 19 Patel MC, Flower CD. Radiology in the management of pleural disease. Eur Radiol 1997; 7: 1454-1462
  CrossrefPubMedGoogle Scholar
• 20 Hirsch JH, Rogers JV, Mack LA. Real-time sonography of pleural opacities. AJR Am J Roentgenol 1981; 136: 297-303
  CrossrefPubMedGoogle Scholar
• 21 Vignon P, Chastagner C, Berkane V. et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med 2005; 33: 1757-1763
  CrossrefPubMedGoogle Scholar
• 22 Roch A, Bojan M, Michelet P. et al. Usefulness of ultrasonography in predicting pleural effusions >500 mL in patients receiving mechanical ventilation. Chest 2005; 127: 224-232
  CrossrefPubMedGoogle Scholar
• 23 Opacic M, Bilic A, Ljubicic N. et al. Thoracocentesis under ultrasonographic control. Acta Med Iugosl 1991; 45: 71-75
  PubMedGoogle Scholar
• 24 Kohan JM, Poe RH, Israel RH. et al. Value of chest ultrasonography versus decubitus roentgenography for thoracentesis. Am Rev Respir Dis 1986; 133: 1124-1126
  PubMedGoogle Scholar