الفهرس 
Value of chest ultrasound in management of pleural effusion
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Abstract
Pleural effusion is one of the most common diseases with a high hospitalization rate and is potentially life threatening. Chest ultrasound (US) is increasingly being used as a valuable bedside tool in the diagnosis of various thoracic conditions, especially pleural effusion chest US can also be used to assess pleural fluid volume and character, revealing possible underlying pathologies and guiding management. The British Thoracic Society (BTS) guidelines recommend that all thoracentesis must be performed with ultrasound guidance.
Patient and methods:. Study included one hundred patients diagnosed pleural effusion by chest X-Ray they were referred to the cardiothoracic department in Kasr Al-Ainy hospital for management from February 2020 to October 2021 .The aim of this study was to evaluate the value of chest ultrasound in management of pleural effusion. Patients evaluated by the following age, gender, compliant, diagnosis, CXR also all patients preformed chest US. Management of pleural effusion according to US finding classified into 3 group: Group(A) drainage of pleural effusion either Ultrasound Guided Thoracocentesis or Tube Thoracostomy localized by US, group (B) surgical management open thoracotomy or VATS, group (C) conservative management.
Results: study included 71 male and 29 female patients, with mean age 47± 13.06 years. Infection was the most frequent cause of effusion (47%). The most common complaint is dyspnea (54%). Chest US finding:1) loculated effusion (47%), 2) free effusion (53%). Most frequent echo structure of free effusion was mostly non septate 60%, whereas loculated effusion was septate in 40% 3) size of effusion : mild 25%, moderate 61% and sever 14%. 4)Diaphragm movement: Normal movement 86%, fixed diaphragm 14%. 5)Pleural thickness: minimum 3.5mm maximum 7.8mm with mean 5.03mm ± 1.23mm .Management of patients according US finding classified into group (A) Drainage US guided thoracocentesis 40% and Tube thoracostomy localized by US 21% ,Group(B)Surgical open thoracotomy 14% and VATS 14%, Group( C) Conservative management 11%.
Ultrasound data showed great value (P-vale <0.001) in categorized patients according to our protocol management into 3 groups regarding type of effusion, echo structure, size of effusion, thickness of pleura and diaphragm movement .Size of effusion has statistically significant value in group (A) between ultrasound guided thoracocentesis or Tube Thoracostomy localized by US while type of effusion, echo structure, thickness of pleura and diaphragm movement has no significant value. In group (B) diaphragm movement, and pleural peel thickness less than 5.33mm are US parameters show significant value .For conservative management in group (C) US reveled most of them was free effusion, usually mild and non-septate effusion with normal diaphragm mobility and pleural thickness. Only 5% had complications in our study in the form of pneumothorax and entrapped lung with bronchopleural fistula.
Conclusion: thoracic ultrasound is a very useful tool in diagnosis and management options in patients with pleural effusions of a different origin with low incidence of complication.