THE UTILITY OF CHEST ULTRASOUND IN EARLY DETECTION OF OUTCOME OF PLEURODESIS IN PATIENTS WITH PLEURAL DISEASES

Abstract

SUMMARY T he chest ultrasound can easily visualize pleural effusions, they are characterized by the echo-free space between the visceral and parietal pleura whose shape can change with respiration (Yang et al., 1992). In most patients with malignant pleural effusion, palliative treatment requires pleurodesis with sclerosing agents. The most cost-effective method for controlling of malignant pleural effusion is drainage through thoracostomy tube and intrapleural instillation of a chemical agent "pleurodesis". One of the easiest signs to identify during chest sonography is the movement of the visceral pleura compared to immobility of the parietal pleura ‘pleural gliding’. The current study is the first to date to present results of studying the effect of pleurodesis on the gliding sign with the ultrasound. The study was conducted in Ain Shams University hospitals, in which 20 patients presented with pleural diseases either pneumothorax or malignant pleural effusion were included. They included 12 males and 8 females. Chest ultrasound was performed just before pleurodesis and then repeated after 2 weeks of the procedure. The outcome of pleurodesis was followed after 2 months for clinical and radiological evidence of recurrence of pleural effusion. In case of pneumothorax the evidence of success was based on ultrasonographic evidence of persistently absent pleural sliding The identified outcome was plotted against early ultrasonographic findings. Ultrasound done 15 days after trial of pleurodesis showed absence of gliding sign in the scapular line in (70%) of the patients compared to no abnormalities in the gliding prior to the procedure and in mid axillary line in (60%) of the patients and in midclavicular area in (35%) of the patients compared to no abnormalities in the gliding prior to pleurodesis. Chest ultrasound found that pleurodesis was fully successful as judged by score of 19-21 in (35%) of cases and also was able to detect failure of the procedure as judged by a score 3-8 in (20%) of cases Besides the early recognition of the outcome of pleurodesis US demonstrated the major advantage of verification of symphysis of the pleural space as judged by absent gliding sign, totally in all examined lines in 7 cases and partially in variable number of lines in 9 cases with complete failure in 4 cases. Investigation for underlying lung changes that might support the prediction of successful pleurodesis in cases w