Pleural ultrasound – indications, preparation for examination, course

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The pleural ultrasound is part of the FAST ultrasound. It is a test performed most often in the case of suspicion of the presence of pleural fluid. Based on the ultrasound examination of the lungs and pleural cavities, it is also possible to diagnose edema, inflammatory changes, tumors, pulmonary embolism or pneumothorax. What are the indications for an ultrasound of the pleural cavity and what does the examination involve?

Lung ultrasound or X-ray?

Ultrasound examination is one of the most common diagnostic methods. It is used because it is non-invasive, has no contraindications or the risk of complications. Ultrasound safety results from the use of ultrasounds that are not harmful to the body. Nevertheless, X-ray imaging is most often associated with X-ray, but it is not the only method of effective disease detection.

Chest X-ray is considered the standard lung imaging test. X-ray is distinguished by high diagnostic value and is often recommended as a prophylactic examination in lung diseases. It is used to identify the source of clinical symptoms and to diagnose diseases such as tuberculosis, pneumonia or neoplastic changes. However, X-ray examination has its limitations. It cannot be performed in pregnant women and is less accurate than ultrasound.

The advantage of lung ultrasound over X-ray is the possibility of accurate assessment of pleural cavities for any residual fluid there. It also allows you to detect changes up to 0,1 mm in size. Unfortunately, the changes visible in this study should adhere to the pleural surface in order to be visible. In the pleural cavity ultrasound, we will not see the deeper areas of the lungs, but we will get such an image on X-rays. Therefore, ultrasound examination often has an auxiliary function and is performed additionally as a supplement to other tests.

1. See also: X-ray of the lungs – how to interpret the results?

Indications for ultrasound of the pleural cavity

Performing ultrasound of pleural cavities it is recommended by a doctor, especially in a situation where there is a suspicion of excess fluid in them. Under natural conditions, the pleural cavity contains no more than 10 ml of serous fluid, which acts as a moisturizer and facilitates the movement of the lungs while breathing. Excess fluid indicates various diseases such as tuberculosis, pneumonia, and lung cancer. Due to the high sensitivity of ultrasound, even a small amount of this fluid can be detected on its basis.

The pleural fluid requires testing to make a diagnosis. Also in this context, ultrasound of the pleural cavity is useful, as it allows for the exact localization of the place of fluid accumulation. On this basis, the doctor determines the injection site in order to collect a sample for examination.

Not only the fluid in the pleural cavities is an indication for ultrasound examination. Its performance also allows you to see changes in the tissue structure:

1. injuries;
2. inflammatory changes (including pneumonia or pleura);
3. neoplastic changes;
4. radiological changes;
5. abnormalities not only of the lungs and pleura, but also of the mediastinum and chest walls.

Other indications for ultrasound of the pleural cavity have:

1. pregnancy that makes it impossible to perform an X-ray;
2. monitoring the treatment of lung conditions, including control of infiltrates arising from diseases such as pneumonia;
3. pain and shortness of breath in a patient or tiring cough, as well as a cough with sputum;
4. detecting the carrier of the BRCA1 or BRCA2 gene, which is a factor that increases the patient’s risk of developing certain types of cancer. By performing an ultrasound of the lungs and therefore of the chest area, lumps may be detected that may indicate a tumor is developing. Within the lungs, metastases are also observed in patients with e.g. for breast, ovarian, testicular, thyroid, kidney and melanoma cancer.
5. Read more about detecting the genetic tendency of cancer: Genetic testing – what cancers can be predicted?

Pleural ultrasound – preparation and course

As in the case of other ultrasound examinations, the pleural ultrasound does not require any preparation. During the examination, the patient uncovers his chest so that the doctor can cover the area with a gel that facilitates the propagation of ultrasound. Then it uses an ultrasound probe of the appropriate shape and moves it over the surface of the skin. Is displayed on the monitor image of the lungs and pleural cavitiesand the doctor can assess the condition of internal organs and structures. The images are discussed with the patient on an ongoing basis, and finally, a specialist description is prepared for the ultrasound.

Price of ultrasound of pleural cavities is 100–120 PLN on average, and the duration of the test is usually from a few to several minutes. A full interview and consultation visit may take half an hour.

What diseases can the pleural cavity ultrasound detect?

Ultrasound examination of the lungs and pleural cavities is used in basic and specialized diagnostics, as well as to detect life-threatening conditions. It is successfully carried out in adults, pregnant women and children. It is particularly effective in diagnosing pneumonia. On its basis, bacterial inflammation is distinguished from viral or fungal.

Based on ultrasound of the lungs and pleural cavity it is possible to diagnose:

1. pleural empyema and lung abscess;
2. pulmonary embolism;
3. pulmonary tuberculosis;
4. pneumothorax;
5. bruises and lung injuries;
6. bleeding into the pleural cavity;
7. tumors of the chest integuments, but also of the thymus and lymph nodes;
8. lung and pleural cancer (e.g. pleural mesothelioma);
9. heart failure, cirrhosis, or pericardial disease, which may be indicated by pleural fluid.