Post-Thoracentesis Ultrasound Versus Chest Radiography for the Evaluation of Effusion Evacuation and Lung Reexpansion: A Multicenter Study

<b>Rationale:</b> Post-thoracentesis chest radiography (CXR) is often used to evaluate the degree of residual fluid after thoracentesis. Whether post-drainage ultrasound examination is comparable to CXR in the evaluation of pleural space evacuation is unknown. <b>Objectives:</b> How do post-thoracentesis ultrasound and CXR compare in assessing the effectiveness of pleural space evacuation? <b>Methods:</b> In this prospective, multicenter study, patients with free-flowing pleural effusions with minimal to no septations requiring thoracentesis were recruited. Post-thoracentesis ultrasound was performed immediately postprocedure; CXR was performed within 4 hours postprocedure. The primary outcome was agreement on complete pleural space evacuation between ultrasound and CXR. Complete pleural space evacuation was defined as the absence of pleural fluid on anterior, midaxillary, and posterior ultrasound views and lack of costophrenic angle blunting on CXR. Interobserver reliability was assessed via independent image reviews by two pulmonologists and two radiologists blinded to patient and procedure data, with disagreements resolved by a third reviewer. <b>Results:</b> Of the 147 patients enrolled (February 2021-May 2022), 145 were included in the final analysis. The median age was 64 years (56-75), and malignancy was the most frequent effusion etiology (<i>n</i> = 49). The lung was considered trapped in 50% (<i>n</i> = 73). A total of 826 ultrasound images were collected for blind review. The Gwet's agreement coefficient 1 assessing complete pleural evacuation between ultrasound and CXR was 0.93 (95% confidence interval [CI], 0.83-1.00). When assessing agreement on the basis of pre-specified criteria of effusion size (small vs. large), a substantial level of agreement was observed between ultrasound and CXR, indicated by a kappa of 0.64 (95% CI, 0.51-0.77). There was strong agreement (kappa = 0.81; 95% CI, 0.71-0.90) between proceduralist and blind ultrasound reviewers regarding complete pleural space evacuation. <b>Conclusions:</b> Post-thoracentesis ultrasound is an equally effective alternative to CXR in evaluating pleural space evacuation in simple pleural effusions.

Authors

Institutions

Publication Details

Journal
Annals of the American Thoracic Society
Published
2025-05-29
DOI
https://doi.org/10.1513/annalsats.202410-1095oc
Citations
1
Primary Topic
Ultrasound in Clinical Applications
Type
article
Field-Weighted Citation Impact
1.55
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Post-Thoracentesis Ultrasound Versus Chest Radiography for the Evaluation of Effusion Evacuation and Lung Reexpansion: A Multicenter Study

David E. Ost, Heidi Chen, Peter M. J. Lee, Danai Khemasuwan et al.
1 citations
Annals of the American Thoracic Society
Ultrasound in Clinical Applications
1.55
article

Post-Thoracentesis Ultrasound Versus Chest Radiography for the Evaluation of Effusion Evacuation and Lung Reexpansion: A Multicenter Study

David E. Ost, Heidi Chen, Peter M. J. Lee, Danai Khemasuwan, Jasleen Pannu, Gulmira Yermakhanova, Lonny Yarmus, Ray W. Shepherd, Ankush P. Ratwani, Fabien Maldonado, Muhammad H. Arain, Zachary S. DePew, Otis B. Rickman, Mark S. Parker, Najib Mahboob Rahman, Samira Shojaee, Sheau‐Chiann Chen, Labib Debiane, F Dana, Leila Rezai Gharai, David Feller‐Kopman, Heather G. Mac New, Horiana B. Grosu, Shaikh M. Noor ul Husnain, Robert J. Lentz, Trinidad Sánchez
article en
1 citations

Abstract

<b>Rationale:</b> Post-thoracentesis chest radiography (CXR) is often used to evaluate the degree of residual fluid after thoracentesis. Whether post-drainage ultrasound examination is comparable to CXR in the evaluation of pleural space evacuation is unknown. <b>Objectives:</b> How do post-thoracentesis ultrasound and CXR compare in assessing the effectiveness of pleural space evacuation? <b>Methods:</b> In this prospective, multicenter study, patients with free-flowing pleural effusions with minimal to no septations requiring thoracentesis were recruited. Post-thoracentesis ultrasound was performed immediately postprocedure; CXR was performed within 4 hours postprocedure. The primary outcome was agreement on complete pleural space evacuation between ultrasound and CXR. Complete pleural space evacuation was defined as the absence of pleural fluid on anterior, midaxillary, and posterior ultrasound views and lack of costophrenic angle blunting on CXR. Interobserver reliability was assessed via independent image reviews by two pulmonologists and two radiologists blinded to patient and procedure data, with disagreements resolved by a third reviewer. <b>Results:</b> Of the 147 patients enrolled (February 2021-May 2022), 145 were included in the final analysis. The median age was 64 years (56-75), and malignancy was the most frequent effusion etiology (<i>n</i> = 49). The lung was considered trapped in 50% (<i>n</i> = 73). A total of 826 ultrasound images were collected for blind review. The Gwet's agreement coefficient 1 assessing complete pleural evacuation between ultrasound and CXR was 0.93 (95% confidence interval [CI], 0.83-1.00). When assessing agreement on the basis of pre-specified criteria of effusion size (small vs. large), a substantial level of agreement was observed between ultrasound and CXR, indicated by a kappa of 0.64 (95% CI, 0.51-0.77). There was strong agreement (kappa = 0.81; 95% CI, 0.71-0.90) between proceduralist and blind ultrasound reviewers regarding complete pleural space evacuation. <b>Conclusions:</b> Post-thoracentesis ultrasound is an equally effective alternative to CXR in evaluating pleural space evacuation in simple pleural effusions.

Annals of the American Thoracic SocietyVol. 22(9)
Creighton University (US), Saint Thomas West Hospital (US), Dartmouth–Hitchcock Medical Center (US), CARE USA (US), Saint Thomas Health (US), Westchester Medical Center (US), The University of Texas MD Anderson Cancer Center (US), Johns Hopkins University (US), Henry Ford Health System (US), Oregon Health & Science University (US), Virginia Commonwealth University (US), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Vanderbilt University (US), Johns Hopkins Medicine (US), CHI Health Creighton University Medical Center - Bergan Mercy (US), University Health System (US), The Ohio State University Wexner Medical Center (US), Health Net (US), Henry Ford Hospital (US), National Institute for Health and Care Research (GB), University of Oxford (GB), Dartmouth Psychiatric Research Center (US), Pulmonary and Allergy Associates (US), Science Oxford (GB), Pulmonary and Critical Care Associates (US), Children's Hospital of Richmond at VCU (US), Dartmouth Health (US), The Ohio State University (US), Vanderbilt University Medical Center (US)
Good health and well-being
Openalex Percentile: Top 19%
Ultrasound in Clinical Applications
1.55
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.