Thorax 64:139-143 doi:10.1136/thx.2008.100545
  • Pleural disease

Thoracic ultrasound in the diagnosis of malignant pleural effusion

  1. N R Qureshi1,
  2. N M Rahman2,
  3. F V Gleeson3
  1. 1
    Department of Radiology, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
  2. 2
    Oxford Centre for Respiratory Medicine and University of Oxford, Oxford Radcliffe Hospital, Oxford, UK
  3. 3
    Department of Radiology, Oxford Radcliffe Hospital, Oxford, UK
  1. Dr F V Gleeson, Department of Radiology, Oxford Radcliffe Hospital, Headington, Oxford OX3 7LJ, UK; fergus.gleeson{at}
  • Received 29 June 2008
  • Accepted 23 September 2008
  • Published Online First 13 October 2008


Background: Malignant pleural effusion (MPE) is a common clinical problem with described investigation pathways. While thoracic ultrasound (TUS) has been shown to be accurate in pleural fluid detection, its use in the diagnosis of malignant pleural disease has not been assessed. A study was undertaken to assess the diagnostic accuracy of TUS in differentiating malignant and benign pleural disease.

Methods: 52 consecutive patients with suspected MPE underwent TUS and contrast-enhanced CT (CECT). TUS was used to assess pleural surfaces using previously published CT imaging criteria for malignancy, diaphragmatic thickness/nodularity, effusion size/nature and presence of hepatic metastasis (in right-sided effusions). A TUS diagnosis of malignant or benign disease was made blind to clinical data/other investigations by a second blinded operator using anonymised TUS video clips. The TUS diagnosis was compared with the definitive clinical diagnosis and in addition to the diagnosis found at CECT.

Results: A definitive malignant diagnosis was based on histocytology (30/33; 91%) and clinical/CT follow-up (3/33; 9%). Benign diagnoses were based on negative histocytology and follow-up over 12 months in 19/19 patients. TUS correctly diagnosed malignancy in 26/33 patients (sensitivity 73%, specificity 100%, positive predictive value 100%, negative predictive value 79%) and benign disease in 19/19. Pleural thickening >1 cm, pleural nodularity and diaphragmatic thickening >7 mm were highly suggestive of malignant disease.

Conclusion: TUS is useful in differentiating malignant from benign pleural disease in patients presenting with suspected MPE and may become an important adjunct in the diagnostic pathway.


  • See Editorial, p 97

  • ▸ Additional details of the techniques, statistical analysis and figures are published online only at

  • Funding: None specific to this study. NMR is funded by an MRC Training Fellowship.

  • Competing interests: None.

  • Ethics approval: The study was discussed with the Chair of the Oxford Research Ethics Committee and considered an audit of practice not requiring specific ethics approval.