ROUTINE ECHOCARDIOGRAPHIC VIEWS MISS SIGNIFICANT PLEURAL EFFUSIONS - BILATERAL CHEST SCANNING IS REQUIRED

Objectives: To determine the benefit of adding chest scanning to the r outine echocardiographic examination to diagnose pleural effusions. Ba ckground: Pleural effusions are common in several cardiac disorders, y et routine echocardiography is insensitive in, delineating pleural flu id. Methods: Bilateral chest scanning was performed in addition to the routine echo examination in 100 consecutive inpatients referred for e chocardiography with recent chest X rays (CXRs). Detection and quantif ication of pleural effusion, by sonographic chest scanning was compare d blindly with CXRs. Identification of pleural fluid was analyzed for correlation with clinical diagnosis of congestive heart failure (CHF) and elevated pulmonary artery pressures if found by echo-Doppler exami nation. Results: Agreement on presence or absence of pleural effusion occurred in. 88 of 100 patients-in 5 patients bilateral chest scanning detected pleural effusion with negative CXRs; in 7 patients CXRs sugg ested pleural effusion with negative bilateral chest scanning (all 7 p atients had minor blunting of the costophrenic angle). Routine echo vi ews only detected 22 of 51 patients (43%) with pleural effusion detect ed by bilateral chest scanning. In. 45 patients with CHF, 29 (64%) had pleural effusion. by bilateral chest scanning (25 bilateral, 1 left, 3 right) vs 12 (27%) by routine echo (only left pleural effusion, seen ). Ejection, fraction and estimated pulmonary artery pressure did not differ between CHF patients with and without pleural effusion. Conclus ions: Routine echocardiographic views underestimate the presence of pl eural effusion in patients referred for study. Bilateral chest scannin g is equal to CXRs for pleural effusion, detection and provides clinic ally useful information which may be of particular benefit to patients with CHF.