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Improving the care of sleep apnoea
P122 The Use of Thoracic Ultrasound in Management of Patients with Pleural Disorders
  1. JA Kastelik,
  2. I Aslam,
  3. JB Morjaria,
  4. AG Arnold
  1. Department of Respiratory Medicine, Castle Hill Hospital, Cottingham, East Yorkshire, UK

Abstract

Introduction Pleural diseases are common reason for referral to respiratory specialists. Thoracic ultrasound has become an important tool for investigation and management of patients with pleural diseases. Thoracic ultrasound allows real-time assessment of the pleural space as well as acquired wide use in guiding pleural procedures. Current British Thoracic Society (BTS) guidelines strongly recommend the use of thoracic ultrasound for the investigation and management of patients with pleural disorders.

Aims To review experience of using thoracic ultrasound by respiratory physicians for investigations and management of patients with pleural disorders.

Methods Retrospective analysis of thoracic ultrasound procedures performed in a tertiary hospital by respiratory physicians.

Results Over a period between July 2008 and July 2012 a total of 680 thoracic ultrasound procedures were performed by respiratory physicians in 388 (153 females) patients, mean (range) age 63.4 (17–97) years. The findings of thoracic ultrasound included: 240 cases of pleural effusion, 38 cases of pleural infection including parapneumonic effusion or empyema, 36 cases of consolidated lung, 24 pneumothoraces, 15 cases of pleural thickening, 6 cases of diaphragmatic abnormalities and 6 cases of other abnormalities such as hydropneumothorax, chylothorax or evidence of pleurodesis were recorded. Moreover in 23 cases no anomalies were noted. The most common underlying causes for pleural effusion included malignancy, cardiac failure and infection. Overall 70 pleural procedures such as intercostal chest drain insertion or thoracocentesis were performed.

Conclusions Thoracic ultrasound performed by respiratory physicians has become a part of routine management of patients with pleural disorders. From our observations the most frequent finding on performing thoracic ultrasound was pleural effusion, however this modality of investigation also enabled identification of other conditions such as consolidated lung or diaphragmatic abnormalities that could on chest radiograph mimic pleural effusion, hence potentially avoiding unnecessary pleural procedures. More importantly thoracic ultrasound was used to guide pleural procedures such as thoracocentesis or intercostal chest drain insertion. Using our findings we recommend the routine use of thoracic ultrasound for the initial investigation and management of patients with pleural disorders as it is a safe, convenient and cost-effective tool.

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