Mk. Urman et C. Pollick, ROUTINE ECHOCARDIOGRAPHIC VIEWS MISS SIGNIFICANT PLEURAL EFFUSIONS - BILATERAL CHEST SCANNING IS REQUIRED, Echocardiography, 12(5), 1995, pp. 449-455
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.