We read with interest the article by Qureshi and colleagues describing thoracic ultrasound (TUS) characteristics for the detection of malignant pleural effusions.1 This relatively simple bedside technique has been routinely performed by the respiratory physicians in our department in a busy general hospital for the last 4 years, resulting in a gradual reduction in the number of radiology departmental procedures from 63 to 17 per annum.

A recent audit of our activity showed that over a period of 18 months, 102 bedside TUS procedures were performed (table 1). The main indications for TUS included confirmation of the presence of a small pleural effusion, and guidance for pleural procedures. In 71 cases TUS confirmed the radiological findings, with discordant findings in the remaining 31 cases. The TUS findings were crucial in 30 cases, showing either an absent or a very small pleural effusion, not suitable for an invasive pleural procedure. In a further 10 patients TUS facilitated case monitoring. TUS provided guidance in all cases requiring a pleural procedure; 48 and 8 for chest drain insertion and needle aspiration, respectively. None of the subsequent procedures had any associated complications.

Use of TUS decreases the complications associated with pleural procedures,2 which may result in serious harm or even death.3 Recent British Thoracic Society advice on chest drain insertion has advocated the use of ultrasound image guidance.4 Our experience confirms that TUS can be employed by respiratory physicians both as a diagnostic aid and for guiding procedures, and not just in major centres. Cost benefits also accrue from a decrease in the number of scans performed in the radiology department, and in the time involved in waiting for them. Therefore, we would support increased use of this technique by respiratory physicians, after appropriate training, for which guidance already exists.5 The recognition of the characteristics of malignant pleural effusion as described by Qureshi and colleagues may, however, require a higher level of expertise in the interpretation of TUS findings, as well as the use of high frequency ultrasound probes.2 This may have training implications for respiratory physicians if we wish to maximise the potential benefits of TUS in diagnosing malignant pleural effusions, rather than limit the technique to the support of diagnosis of pleural effusions and safer invasive procedures.