The role of ultrasound in the diagnosis of pleuro-pulmonary and peridiaphragmatic diseases

A total of 56 patients with peripheral pleuro-pulmonary opacities were examined with ultrasound. In 44 of these patients (79 of total) ultrasonic findings were confirmed as abnormal in 50 hemithoraces (lesions) (50 out of 88) by direct confirmatory procedures which consisted of postmortem (15 lesions ), surgery (7 lesions) and aspiration (28 lesions). Ultrasound could distinguish the abnormalities between fluids and solids with a sensitivity of 95.4% for fluids (n=44) and a sensitivity of 85% for solids (n=13). Considering the direct confirmatory (postmortem/surgery/aspiration), the other radio diagnostic procedures (CT-scan and decubitus radiograph) and fluid diagnosed on clinical suspicion, the sensitivity of ultrasound to fluid was minimally reduced from 95.4% n=44 to 95.2% n= 63 while the sensitivity of ultrasound to solids was minimally increased from 85% (n=13) to 88% (n=16). Sensitivity of decubitus radiograph to fluid was demonstrated in this study to be only 67% (n=9). Ultrasound identified the right diaphragm with certainty in all patients (100% of 56) and the left one in 76% of all cases. Diaphragmatic motion was measured in 29 patients (52% of total) one the right and was demonstrated to be reduced in eleven patients (38% of the 29), all of whom had ipsilateral (8 out of 11) or bilateral (3 out of 11) intra-pulmonary pathologies. Abnormalities involving the diaphragms, vessels, peritoneum and upper abdominal viscera in combination with pleuro-combination with pleuro-pulmonsty diseases are demonstrated and discussed. It is concluded that ultrasound is able to detect define extent and resolve pleuro-pulmonary and peridiaphragmatic lesions into solids and fluids with an accuracy high enough to justify its use as a complimentary diagnostic modality to the conventional radiograph.