Qureshi and colleagues achieved impressive results using thoracic ultrasound (TUS) to predict malignant pleural effusion in their recent study.1 TUS in their hands compared reasonably well with pleural CT.

However, we suggest that pleural CT still remains the gold standard and cannot be replaced by TUS except in situations where access to pleural CT is difficult. First, even in their expert hands, six out of the seven false-negative TUS examinations were resolved by pleural CT. The priority in the real …