Post-thoracentesis Ultrasound vs. Chest X-ray for the Evaluation of Effusion Evacuation and Lung Re-Expansion, A Multicenter Study
Recommended Citation
Ratwani A, Grosu HB, Husnain SMN, Sanchez TM, Yermakhanova G, Pannu J, Debiane LG, DePew Z, Yarmus L, Maldonado F, Lentz RJ, Rickman OB, Feller-Kopman D, Arain MH, New H, Chen H, Chen SC, Ost DE, Dana F, Rezai Gharai L, Parker M, Lee PM, Khemasuwan D, Shepherd RW, Rahman NM, and Shojaee S. Post-thoracentesis Ultrasound vs. Chest X-ray for the Evaluation of Effusion Evacuation and Lung Re-Expansion, A Multicenter Study. Ann Am Thorac Soc 2025.
Document Type
Article
Publication Date
5-29-2025
Publication Title
Ann Am Thorac Soc
Abstract
INTRODUCTION: Post-thoracentesis chest radiography (CXR) is often used to evaluate the degree of residual fluid post-thoracentesis. Whether post-drainage ultrasound exam is comparable to CXR in the evaluation of pleural space evacuation is unknown.
RESEARCH QUESTION: How do post-thoracentesis ultrasound and CXR compare in assessing the effectiveness of pleural space evacuation?
METHODS: 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 post-procedure; CXR was performed within 4-hours post-procedure. 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, mid-axillary, 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/procedure data, with disagreements resolved by a third reviewer.
RESULTS: 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 (n=49). The lung was considered trapped in 50% (n=73). A total of 826 ultrasound images were collected for blind review. The Gwet's Agreement Coefficient 1 (AC1) assessing complete pleural evacuation between ultrasound and CXR was 0.93 (95% CI: 0.83-1.00). When assessing agreement based on the 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 a strong agreement (kappa= 0.81 (95% CI: 0.71-0.90)) between proceduralist and blind ultrasound reviewers regarding complete pleural space evacuation.
CONCLUSION: Post-thoracentesis ultrasound is an equally effective alternative to CXR in evaluating pleural space evacuation in simple pleural effusions.
PubMed ID
40439529
ePublication
ePub ahead of print
