Role of chest ultrasound in patients with peripheral thoracic lesions

Abstract

Background Transthoracic ultrasound (US) is useful in the evaluation of a wide range of peripheral, parenchymal, pleural, and chest-wall diseases. Aim To evaluate the role of chest US in the diagnosis of peripheral thoracic lesions. Patients and methods A prospective interventional analytical study was included: 40 adult patients with peripheral thoracic lesions. Transthoracic US (Philips Affinity 50 G U/S, made in Germany) was performed using a linear 5–10-MHz probe for examination of the thoracic wall and the parietal pleura, whereas a 2–5-MHz convex probe was used to examine the visceral pleura, pleural effusion, and lung parenchyma. US-guided core biopsy (Tru cut needle 16 G×10 cm), fine-needle aspiration, or both were performed. Different diagnostic procedures such as bronchoscopy, thoracoscopy, or computed tomography-guided biopsy were done to approach the final confirmatory histopathological diagnosis. Results The final confirmatory diagnosis was approached in 38/40 (95%) patients, while 2/40 (5%) patients were undiagnosed due to morbidity or discharge. The frequent transthoracic US findings were pleural effusion (82.5%), pleural thickening (52.5%), and lung collapse (47.5%). While lung abscess (2.5%) and lung nodules (2.5%) were less-frequent findings. Regarding the diagnostic procedure, 11/38 patients of the studied population were diagnosed by US-guided biopsy, 16/38 cases were diagnosed by US-guided aspiration, and 2/38 cases were diagnosed by both US-guided biopsy and aspiration. Moreover, 1/38 cases were diagnosed by computed tomography-guided biopsy because the result of US-guided biopsy was inconclusive. Fiber-optic bronchoscopic biopsy was carried out in 2/38 patients who had endobronchial central lesion. Another 5/38 cases were diagnosed by thoracoscopic biopsies after a trial of US-guided biopsy failure. Transthoracic US had a diagnostic utility of 83, 67, 97, and 25% sensitivity, specificity, positive, and negative predictive value, respectively. Conclusion Transthoracic US is a practical, cheap, and safe method for diagnosis of peripheral lung lesions and pleural diseases.

Keywords

• chest ultrasound
• peripheral lesions
• pleural diseases