Abstract
Background: Pleural disease is common, affecting 1 in 300 people annually. The incidence of malignant pleural effusion is increasing with 40000 cases in the UK each year. Pleural drainage is frequently performed for diagnostic and therapeutic reasons in patients with new effusions. There is disagreement about whether effusions should be drained partially or completely before diagnostic imaging is performed. Residual fluid can help with visualising pleural abnormalities, but some clinicians worry that incomplete reexpansion of the underlying lung impairs parenchymal assessment.
Method: We reviewed medical records for patients with a new unexplained pleural effusion who underwent medical thoracoscopy (MT) in Oxford between 01/2010 and 07/2012. An assessor blind to the patient's final diagnosis reported pre- and post-MT imaging (CXR +/- CT), categorising studies as benign, uncertain or malignant. Post-MT imaging was specifically assessed to see whether complete drainage of the effusion revealed a clinically relevant lung abnormality that would change management.
Results: 111 cases were included. In only one case (1/111, 0.9%) did post-drainage CXR reveal an abnormality not evident on the pre-drainage film that would have influenced subsequent care. 28/111 (25.2%) cases had pre- and post-drainage CT available - none of these patients had additional information relevant to their diagnostic pathway identified on post-drainage imaging.
Conclusion: Complete drainage of pleural effusions aimed at maximising radiological diagnostic potential in the lung parenchyma does not add any relevant value to imaging studies. Prospective work with greater patient numbers is needed to confirm this preliminary finding.
- Copyright ©ERS 2015