Comparative Analysis of Thoracic Ultrasound and Contrast-Enhanced CT in Diagnosing Pleural Empyema: A Cross Sectional Study

Background: Thoracic ultrasound (TUS) and contrast-enhanced CT (CECT) are integral in pleural empyema diagnosis. Objective: To compare diagnostic yield, accuracy, and clinical utility of TUS vs CECT in confirmed empyema. Methods: Cross-sectional study done on 80 adult patients with suspected empyema presenting to Saraswathi Institute of Medical Sciences, Hapur Casualty, IPD or OPD. Patients underwent TUS and CECT Thorax. Sensitivity/specificity for effusion, septation, loculation, and split pleura sign were calculated. Procedural guidance, safety, cost, and time to intervention were evaluated. Results: TUS detected effusions in 98%, septations in 85%, and loculations in 83%. CECT detected septations in 60% and split pleura in 75%. Sensitivity of TUS vs CECT: effusion (98% vs 90%), septation (85% vs 60%), loculation (83% vs 65%). TUS enabled bedside drainage in 92% and avoided CECT in 60% of patients. Conclusion: TUS demonstrated superior sensitivity for internal septations and loculations and provides real time, radiation free, cost effective bedside guidance. CECT is complementary for anatomical delineation and surgical planning.