Pleural effusion: ultrasound was a better test than chest X-ray for detecting effusions.

Clinical bottom line (level 4)

  1. Ultrasound was a better test for diagnosing or excluding pleural effusions than chest X-ray.
Gryminski et al: Chest 1976; 70 (1): 33-37
Expires October 2003

The study

Setting: university hospital, Poland

116 patients (aged ?, ?% male) pleural disease and suspected pleural effusion

Non-independent ?blinded reference standard, applied in all patients from a consecutive inappropriate spectrum.
Reference standard:
    • ultrasound-guided thoracocentesis
    • or resolution of appearance of effusion on ultrasound scan, chest X-ray following medical therapy
Diagnostic test:
  • chest X-ray: PA, lateral and lateral decubitus; reviewed by radiologist specialising in chest disease
  • 2-dimensional ultrasound: patients examined sitting upright

The evidence

pre-test probability of pleural effusion: 69%, (95% CI: 61% to 77%)

diagnostic test pleural effusion no pleural effusion LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
ultrasound- fluid detected 74 4 8.3
(3.3 to 21) 		95% 0.084
(0.039 to 0.18) 		16%
chest x-ray- fluid detected 66 14 2.1
(1.4 to 3.2) 		83% 0.29
(0.17 to 0.49) 		39%
total 80 36

Comments

  1. No details given on the causes of the pleural disease, but since the study was performed in a tuberculosis institute, most probably had tuberculosis.

Citation

  1. Gryminski J, Krakowka P, Lypacewicz G: the diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest 1976; 70 (1): 33-37
Search Terms: reference from Pleural effusion chapter in 'Quick Consult Manual to Evidence-based Medicine' by Lee, Hsu and Stasior: publd. Lippincott-Raven, 1997
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

Clinical Question.
Patient pleural disease
Intervention or Exposure ultrasound or chest x-ray
Outcome pleural effusion