Sonography of the pleura

Our plain-English summary of Sonography of the pleura, by J. Reuss (Ultraschall in der Medizin, 2010).

The study

• Author: J. Reuss
• Journal: Ultraschall in der Medizin
• Published: 2010;31(1):8-22, quiz 23-5
• Type of article: Review
• Language: German
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This continuing medical education article, printed in German and English, described how ultrasonography is used to examine the pleura, drawing on the author's experience and published studies. The author outlined examination technique and the sonographic appearance of normal pleura, pleural effusion, empyema, pleurodesis, pleuritis, benign tumours, metastases, mesothelioma, pleural scarring, pneumothorax, artefacts and chest trauma. Cited figures included the following:

• Ultrasound detected effusions from 5–10 ml, compared with about 150 ml on standard chest radiographs.
• Pleural thickening was seen at the painful site in 90% of patients with pleuritis.
• For chest wall invasion by lung tumours, ultrasound had a sensitivity of 89% versus 42% for computed tomography.
• For pneumothorax, ultrasound had a sensitivity of 83–100%.

The author reported that asbestos-induced pleural mesothelioma had reached an incidence of 1.5 per 100,000 per year in Germany. Asbestos plaques appeared as hypoechoic pleural thickening, and about 10% calcified. Plaques could be attributed to asbestos only together with the exposure history. Neither plaques nor asbestos-related diffuse pleural fibrosis could be distinguished sonographically from scarring of other causes, and asbestosis of the lung could not be detected by ultrasound. Computed tomography was described as the standard for mesothelioma, with ultrasound useful for assessing local infiltration and guiding biopsy. The author noted that ultrasound was available immediately in the emergency room and took 2–3 minutes in skilled hands.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was an educational review written for doctors as a continuing medical education unit with a quiz. The author described how ultrasound is used to examine the pleura, the lining around the lungs. It did not report a new study of patients. Where it gave numbers, it usually cited published studies, one of them an earlier study by the author and colleagues. It covered the normal pleura, fluid around the lungs, infection, inflammation, tumors, pleural mesothelioma, collapsed lung and chest injury. On asbestos, the author wrote that asbestos plaques show on ultrasound as darker (hypoechoic) thickening of the pleura and that about 10% of plaques calcify. Plaques seen on ultrasound can be counted as asbestos-related only together with the patient's history, because they cannot be told apart from small scars of other causes. The author stated that asbestosis of the lungs cannot be detected by ultrasound. For pleural mesothelioma, the author noted that few studies have looked at ultrasound and that computed tomography is the gold standard. The author concluded that an added ultrasound examination to clarify local conditions may prove useful.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative educational review (continuing medical education article with quiz); no new study data
• Who was studied: No study population; the article reviewed the use of ultrasound to examine the pleura, drawing on published literature
• Exposure: The main subject was ultrasound imaging of pleural disease. Asbestos exposure was discussed in general terms (no fiber types named) in relation to pleural plaques, asbestos-induced pleuritis and pleural mesothelioma.
• Main results:
  • Asbestos-related pleural plaques were described as recognizable on ultrasound as hypoechoic (darker) pleural thickening.
  • About 10% of pleural plaques calcify, according to a cited source (reference 25).
  • Plaques seen on ultrasound can be considered asbestos-induced only together with the patient's history. Ultrasound cannot distinguish them from small scars of other origin.
  • Besides plaques, the author described asbestos-induced pleuritis, with an initial pleural effusion followed by diffuse pleural fibrosis.
  • Asbestosis of the lungs cannot be detected by ultrasound.
  • The author gave the incidence of asbestos-induced pleural mesothelioma in Germany as 1.5 per 100,000 new diagnoses per year. The latency between asbestos exposure and mesothelioma may be several decades, citing reference 24.
  • Few studies have examined ultrasound in diagnosing pleural mesothelioma, and computed tomography is the gold standard.
  • Citing reference 28, the author stated that ultrasound-guided needle biopsy for mesothelioma has a hit rate similar to thoracoscopic biopsy.
• The authors' conclusion: For pleural mesothelioma, the author concluded that an added ultrasound examination to clarify local conditions (spread into the chest wall, diaphragm or pericardium) may prove useful, alongside computed tomography.
• Limitations the authors state:
  • The author noted that there are only a few studies on the value of ultrasound for diagnosing pleural mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleura, Pleural Effusion, Empyema, Pleurodesis, Mesothelioma, Pneumothorax, Ultrasound, Chest X-Ray.

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