Diagnostic Accuracy of Lateral Decubitus Chest Radiography before Pleural Maneuvers for the Management of Pleurisies in the Era of Chest Ultrasound
| Autor: | Sophie Laroumagne, N O Toure, Khady Thiam, Philippe Astoul, Hervé Dutau, Julie Berbis, Julien Guinde, Bertrand Chollet |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Chest ultrasound medicine.medical_specialty Pleural effusion Radiography Physical examination 03 medical and health sciences 0302 clinical medicine Thoracoscopy Humans Medicine 030212 general & internal medicine Pleurisy Aged Retrospective Studies Ultrasonography Aged 80 and over medicine.diagnostic_test business.industry LATERAL DECUBITUS Gold standard (test) Middle Aged respiratory system medicine.disease respiratory tract diseases 030228 respiratory system Female Radiography Thoracic Radiology business |
| Zdroj: | Respiration. 95:449-453 |
| ISSN: | 1423-0356 0025-7931 |
| DOI: | 10.1159/000487999 |
| Popis: | Background: Chest ultrasound (CUS) is the gold standard to detect pleural adhesions before pleural maneuvers. However, the CUS technique is not available in all countries where the assessment is only based on clinical examination and chest radiography. Objective: To assess the value of lateral decubitus chest radiography (LDCR) to detect pleural adhesions. Methods: Consecutive patients with pleural effusions undergoing LCDR followed by medical thoracoscopy the day after were identified from an institutional database. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for LDCR were calculated. Results: Eighty-six patients were included in the study. The sensitivity, specificity, PPV, and NPV of LDCR for the presence of adhesions taking into account the shape of the horizontal level were 71.2% (56.7–82.5), 44.1% (27.6–61.9), 66.1% (52.1–77.8), and 50% (31.7–68.3), respectively. The accuracy to predict pleural adhesions for the sign “incomplete horizontal level” was 60.5 (49.3–70.7). The accuracy to predict pleural adhesions in case of irregular aspect of the horizontal level was 53.5 (42.5–64.2). Conclusions: The accuracy of LDCR for the detection of pleural adhesions is low in patients with pleural effusion and LDCR is not sufficient before pleural maneuvers. This has to be taken into account in countries with a high prevalence of pleural tuberculosis which usually lead to loculated pleural effusions. CUS has to be urgently included in dedicated educational programs in these areas in order to decrease the complications related to unexpected pleural adhesions and achieve better planning for the management of pleural effusions. |
| Databáze: | OpenAIRE |
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