Ultrasound and PET-CT in diagnosis and management of unilateral plural effusions

Research output: ThesisPh.D. thesis

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Abstract

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.
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Bødtger, Uffe, Principal supervisor
  • Clementsen, Paul Frost, Co-supervisor, External person
  • Laursen, Christian Borbjerg, Co-supervisor
  • Bhatnagar, Rahul, Co-supervisor
Publisher
DOIs
Publication statusPublished - 24. Oct 2022

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