Ultrasound and PET-CT in diagnosis and management of pleural effusions

Focused lung ultrasound (FLUS) in the hands of respiratory physicians is an important diagnostic modality. In the PhD project, we examine the prognostic proporties of FLUS in patients with recurrent pleural effusion including prediction of time to next thoracentesis, association between diaphragmatic movement and selv-reported dyspnea change after thoracentesis, and ability of extended FLUS to identify cause of pleural effusion. Furthermore, we performed a systematic review on the diagnostic role of PET-CT of malignancy in patients with recurrent pleural effusion.

In patients with recurrent pleural effusion:
1) Impaired diaphragmatic movement before thoracentesis was not associated with symptom relief after thoracentesis, thus FLUS diaphragma has no obvious role in the decision of definitive pleural interventions (pleurodesis or indweliing pleural catheders);
2) Patients and doctors are equally inable to predict time to next thoracentesis, thus an as-needed approach rather than fixed appointments is recommended in this patient group;
3) US neck, heart or liver did not identify clinical important findings in a cohort with recent chest-CT;
4) The negative predictive value of PET-CT is very high (negative likelihood ratio 9.9), thus a negative PET-CT rules out malignancy with high certainty.