Role of chest ultrasound in determining the nature of pleural effusion in children

ABSTRACT

Because of its ready availability and ability for bed side imaging, sonography has become a major imaging modality not only in determining the presence of pleural fluid and its nature, but also as a guide to aspiration. The pleura is a relatively superficial structure and therefore, it is accessible to sonography. The aim of our work was to investigate the usefulness of sonographic findings, including the internal echegenicity and associated changes in the pleura and lung parenchyma, in determining the nature of pleural effusion, and to compare the results with the CT findings, and those of pleural aspirate. This study was conducted on 50 children suffering from pleural effusion ranging in age between 2 months and 13 years. They were subjected to full history taking, clinical examination, laboratory investigations, laboratory analysis of pleural aspirate, chest Xray, CT chest [if needed] and chest ultrasound. The results of our study revealed that pleural fluid appearance in chest ultrasonography was classified into four main categories anechoic in 50%; complex non septated in 16.7%; complex septated in 8.3%; and homogeneously echogenic in 25% of cases. We regarded transudates [45.8%] as usually anechoic. Exudates [28.2%] were considered when the pleural effusion was complex septated and non septated. Empyema [20.8%] was considered in our study in cases with homogeneously echogenic pleural effusion. Chest ultrasonography detected 91% of transudates, 80% of empyema, and all cases with inflammatory exudates