TY - GEN
T1 - Ultrasound and PET-CT in diagnosis and management of unilateral plural effusions
AU - Fjællegaard, Katrine
PY - 2022/10/24
Y1 - 2022/10/24
N2 - Pleural effusion, defined as accumulation of fluid in the pleural space, is a common condition with
many underlying causes. Unilateral pleural effusion is most often caused by malignancy and
inflammation. The incidence of patients with pleural effusion is increasing, thus investigation of
possible modifications to the current guideline in the diagnostic and therapeutic management of
these patients is needed. In patients with pleural effusion, dyspnoea is the main symptom and
impaired diaphragm movement considered the main pathophysiological mechanism. Therapeutic
thoracentesis is one way of relief. Identifying factors associated with a clinically significant
improvement in dyspnoea following drainage and with time to symptomatic pleural fluid
recurrence, may support the shared decision-making concerning the therapeutic management.
This thesis aimed to assess the value of an additional thoracic ultrasound (TUS) and positron
emission tomography- computed tomography (PET-CT) in the diagnostic workup of patients with
unilateral pleural effusion of unknown cause. In addition, I sought to investigate several aspects
concerning the management of patients with recurrent symptomatic pleural effusion with
therapeutic thoracentesis.The thesis is based on data from two prospective, observational, clinical studies and a systematic
review and meta-analysis. I found additional upfront TUS to have limited value in the diagnostic
workup of patients with unilateral pleural effusion in a setting where chest CT is often available.
Integrated PET-CT with visual/qualitative image interpretation may be valuable, but the
supporting evidence is sparse. Concerning patients with recurrent unilateral pleural effusion,
patients and physicians are equally unable to predict the time to next therapeutic thoracentesis,
emphasising the importance of a flexible pleural service. I found daily fluid production and large
effusion size to be correlated with increased hazard of rapid pleural fluid recurrence, while
septations are associated with decreased hazard. These findings may help adjust the expectations
of patients and guide the planning of treatment. I identified patients with a high baseline level of
dyspnoea and a fully drained effusion to be more likely to have a clinically relevant relief in
dyspnoea following drainage. This knowledge may help guide the management of patients with
pleural effusions.
AB - Pleural effusion, defined as accumulation of fluid in the pleural space, is a common condition with
many underlying causes. Unilateral pleural effusion is most often caused by malignancy and
inflammation. The incidence of patients with pleural effusion is increasing, thus investigation of
possible modifications to the current guideline in the diagnostic and therapeutic management of
these patients is needed. In patients with pleural effusion, dyspnoea is the main symptom and
impaired diaphragm movement considered the main pathophysiological mechanism. Therapeutic
thoracentesis is one way of relief. Identifying factors associated with a clinically significant
improvement in dyspnoea following drainage and with time to symptomatic pleural fluid
recurrence, may support the shared decision-making concerning the therapeutic management.
This thesis aimed to assess the value of an additional thoracic ultrasound (TUS) and positron
emission tomography- computed tomography (PET-CT) in the diagnostic workup of patients with
unilateral pleural effusion of unknown cause. In addition, I sought to investigate several aspects
concerning the management of patients with recurrent symptomatic pleural effusion with
therapeutic thoracentesis.The thesis is based on data from two prospective, observational, clinical studies and a systematic
review and meta-analysis. I found additional upfront TUS to have limited value in the diagnostic
workup of patients with unilateral pleural effusion in a setting where chest CT is often available.
Integrated PET-CT with visual/qualitative image interpretation may be valuable, but the
supporting evidence is sparse. Concerning patients with recurrent unilateral pleural effusion,
patients and physicians are equally unable to predict the time to next therapeutic thoracentesis,
emphasising the importance of a flexible pleural service. I found daily fluid production and large
effusion size to be correlated with increased hazard of rapid pleural fluid recurrence, while
septations are associated with decreased hazard. These findings may help adjust the expectations
of patients and guide the planning of treatment. I identified patients with a high baseline level of
dyspnoea and a fully drained effusion to be more likely to have a clinically relevant relief in
dyspnoea following drainage. This knowledge may help guide the management of patients with
pleural effusions.
U2 - 10.21996/jrtg-4d06
DO - 10.21996/jrtg-4d06
M3 - Ph.D. thesis
PB - Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
ER -