• Boris Shkolnik, Marc A Judson, Adam Austin, Kurt Hu, Melissa D'Souza, Alexis Zumbrunn, John T Huggins, Recai Yucel, and Amit Chopra.
• Departments of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY.
• Chest. 2020 Aug 1; 158 (2): 692-697.

BackgroundThere are limited data examining the diagnostic accuracy of thoracic ultrasonography (TUS) in distinguishing transudative from exudative pleural effusions.Research QuestionWhat is the diagnostic accuracy of TUS in distinguishing transudative from exudative effusions in consecutive patients with pleural effusion?Study Design And MethodsConsecutive patients who underwent TUS and subsequently a diagnostic thoracentesis with a pleural fluid analysis were identified. TUS images of the pleural effusions were interpreted by previously published criteria. We evaluated the diagnostic performance of TUS findings in predicting a transudative vs exudative pleural effusions and specific pleural diagnoses.ResultsWe evaluated 300 consecutive pleural effusions in 285 patients. The pleural effusions were classified as exudative in 229 of 300 cases (76%). TUS showed anechoic effusions in 122 of 300 cases (40%) and complex effusions in 178 of 300 cases (60%). An anechoic appearance on TUS was associated with exudative effusions (68/122; 56%) as compared with transudative effusions (54/122; 44%). The presence of a complex-appearing effusion on TUS was highly predictive of an exudative effusion (positive predictive value of 90%). However, none of the four TUS characteristics were highly specific of a pleural diagnosis.InterpretationThoracic ultrasonography is inadequate to diagnose a transudative pleural effusion reliably. Although the TUS findings of a complex effusion may suggest an exudative pleural effusion, specific pleural diagnoses cannot be predicted confidently.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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