![]() ![]() ![]() A systematic review found the most accurate physical exam findings to rule in a pleural effusion were dullness to percussion (positive likelihood ratio of 8.7 95% CI, 2.2–33) and asymmetric chest expansion (positive LR of 8.1 95% CI, 5.2–12.7). 5ĭiagnostic accuracy of physical examination to detect pleural fluid is highly dependent on the size of the effusion and is unlikely to detect effusions <300ml. The most common symptoms related to pleural effusion are non-specific and often indistinguishable from those of the underlying disease process, including cough, dyspnea, and pleuritic chest pain. Pleural effusions are most commonly associated with heart failure, pneumonia, cancer, pulmonary embolism, viral disease, coronary artery bypass surgery, and cirrhosis with ascites. We review the literature on the diagnosis and evaluation of pleural effusions with ultrasound, as well as techniques to examine and drain the pleural space. 4 The purpose of this review is to provide an overview of how point-of-care ultrasound can be utilized by hospitalists in the care of patients with pleural effusions. A national survey in 2012 revealed only 25% of internal medicine residencies have formal curricula to teach point-of-care ultrasonography. However, many hospitalists may not be familiar with use of point-of-care ultrasound. Routine use of pleural ultrasonography may help hospitalists provide high value care by reducing ancillary testing, including CT scans that expose patients to ionizing radiation, and reducing complications of thoracentesis. ![]() For patients with lung cancer, detection of a malignant pleural effusion changes staging to stage IV, regardless of tumor size or lymph node involvement, and hospitalists may discuss more appropriate treatment options with patients and consultants. For patients with parapneumonic effusions, hospitalists can use ultrasound to quantify and characterize pleural fluid to determine whether diagnostic or therapeutic drainage is indicated, as well as to guide performance of thoracentesis. Approximately 44–57% of hospitalized patients with bacterial pneumonia 1, 2 and up to 62% of ICU patients 3 have a pleural effusion. Hospitalists commonly encounter pleural effusions, and their detection and characterization by point-of-care ultrasound can guide management. ![]()
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