We would like to thank Drs Medford and Entwistle for their letter in response to our recent Thorax publication.1 We entirely agree that pleural CT is the gold standard not only in terms of malignant pleural disease but also for intraparenchymal, mediastinal and distant disease. We would suggest that the priority in the “real world” is prompt diagnosis and subsequent management of the pleural effusion, with CT as currently the most useful technique. However, the widespread use of thoracic ultrasound …