CC BY 4.0 · Journal of Health and Allied Sciences NU 2023; 13(03): 301-305
DOI: 10.1055/s-0042-1757446
Review Article

Assessment of Pleural Effusion by Means of Imaging Modalities

Swati Kumari
1   Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, India
1   Department of Radiodiagnosis and Imaging, KS Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, India
› Author Affiliations


Pleural effusion is the fluid collection in the pleural cavity between the parietal and visceral pleura. It is caused by parenchymal diseases such as inflammatory disorders or infection. Pleural effusion can be diagnosed using imaging modalities such as X-ray, computed tomography (CT) scan, ultrasound, and magnetic resonance imaging (MRI).

MRI is rarely performed to investigate pleural effusion due to motion artifacts and has a poor spatial resolution. Benign and malignant pleural effusion can be diagnosed using an X-ray, CT scan, or ultrasound. Pleural effusion volume can be measured by using ultrasound. This article reviews the feasibility of investigating pleural effusion and fluid drainage in medical imaging and compares to find the best modality for its diagnosis.

Description: This article reports the possible options to detect pleural effusion in medical imaging and compares them to find the best modality for its diagnosis.

Publication History

Article published online:
17 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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  • References

  • 1 Kugasia IAR, Kumar A, Khatri A, Saeed F, Islam H, Epelbaum O. Primary effusion lymphoma of the pleural space: report of a rare complication of cardiac transplant with review of the literature. Transpl Infect Dis 2019; 21 (01) e13005
  • 2 Ali A, Ghuman FD, Hasan SM, Iqbal S. Ahsan, Adnan SM. Frequency of bacterial microorganisms in exudative pleural effusion. J Liaquat Univ Med Heal Sci 2021; 20 (02) 148-152
  • 3 Lepus CM, Vivero M. Updates in effusion cytology. Surg Pathol Clin 2018; 11 (03) 523-544
  • 4 Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: a comprehensive review. Clin Respir J 2018; 12 (08) 2309-2320
  • 5 Lee YCG, Fccp M, Fracp F. Pleural embryology and gross structure, circulation, lymphatics, and nerves. In: Textbook of Pleural Diseases. 2020: 37-50
  • 6 Balik M, Plasil P, Waldauf P. et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 2006; 32 (02) 318-321
  • 7 Usta E, Mustafi M, Ziemer G. Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients. Interact Cardiovasc Thorac Surg 2010; 10 (02) 204-207
  • 8 Remérand F, Dellamonica J, Mao Z. et al. Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med 2010; 36 (04) 656-664
  • 9 Lichtenstein D, Hulot JS, Rabiller A, Tostivint I, Mezière G. Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Intensive Care Med 1999; 25 (09) 955-958
  • 10 Lomas DJ, Padley SG, Flower CDR. The sonographic appearances of pleural fluid. Br J Radiol 1993; 66 (787) 619-624
  • 11 Smargiassi A, Inchingolo R, Zanforlin A, Valente S, Soldati G, Corbo GM. Description of free-flowing pleural effusions in medical reports after echographic assessment. Respiration 2013; 85 (05) 439-441
  • 12 Mayo PH, Goltz HR, Tafreshi M, Doelken P. Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation. Chest 2004; 125 (03) 1059-1062
  • 13 Light RW, Macgregor MI, Luchsinger PC, Ball Jr WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77 (04) 507-513
  • 14 Bansal T, Beese R. Interpreting a chest X-ray. Br J Hosp Med (Lond) 2019; 80 (05) C75-C79
  • 15 Khajotia R. Respiratory clinics: mediastinal shift: a sign of significant clinical and radiological importance in diagnosis of malignant pleural effusion. Malays Fam Physician 2012; 7 (01) 34-36
  • 16 Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol 1996; 3 (02) 103-109
  • 17 O'Moore PV, Mueller PR, Simeone JF. et al. Sonographic guidance in diagnostic and therapeutic interventions in the pleural space. Am J Roentgenol 1987; 149 (01) 1-5
  • 18 Eibenberger KL, Dock WI, Ammann ME, Dorffner R, Hörmann MF, Grabenwöger F. Quantification of pleural effusions: sonography versus radiography. Radiology 1994; 191 (03) 681-684
  • 19 Gryminski J, Krakówka P, Lypacewicz G. The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest 1976; 70 (01) 33-37
  • 20 Asciak R, Hassan M, Mercer RM. et al. Prospective analysis of the predictive value of sonographic pleural fluid echogenicity for the diagnosis of exudative effusion. Respiration 2019; 97 (05) 451-456
  • 21 Ohnishi H, Yokoyama A, Yasuhara Y. et al. Circulating KL-6 levels in patients with drug induced pneumonitis. Thorax 2003; 58 (10) 872-875
  • 22 Lipscomb DJ, Flower CDR, Hadfield JW. Ultrasound of the pleura: an assessment of its clinical value. Clin Radiol 1981; 32 (03) 289-290
  • 23 McLoud TCCT. CT and MR in pleural disease. Clin Chest Med 1998; 19 (02) 261-276
  • 24 Traill ZC, Davies RJO, Gleeson FV. Thoracic computed tomography in patients with suspected malignant pleural effusions. Clin Radiol 2001; 56 (03) 193-196
  • 25 Müller NL. Imaging of the pleura. Radiology 1993; 186 (02) 297-309
  • 26 Helm EJ, Matin TN, Gleeson FV. Imaging of the pleura. J Magn Reson Imaging 2010; 32 (06) 1275-1286
  • 27 White PM, Boyd J, Beattie TF, Hurst M, Hendry GM. Magnetic resonance imaging as the primary imaging modality in children presenting with acute non-traumatic hip pain. Emerg Med J 2001; 18 (01) 25-29
  • 28 Hallifax RJ, Talwar A, Wrightson JM, Edey A, Gleeson FV. State-of-the-art: Radiological investigation of pleural disease. Respir Med 2017; 124: 88-99
  • 29 Abrams LD. A pleural-biopsy punch. Lancet 1958; 1 (7010): 30-31
  • 30 Cope C. New pleural biopsy needle; preliminary study. J Am Med Assoc 1958; 167 (09) 1107-1108
  • 31 Corcoran JP, Tazi-Mezalek R, Maldonado F. et al. State of the art thoracic ultrasound: intervention and therapeutics. Thorax 2017; 72 (09) 840-849
  • 32 Yamamoto N, Watanabe T, Yamada K. et al. Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: comparison with computed tomography (CT) guided needle biopsy. J Thorac Dis 2019; 11 (03) 936-943
  • 33 McLoud TC, Woods BO, Carrington CB, Epler GR, Gaensler EA. Diffuse pleural thickening in an asbestos-exposed population: prevalence and causes. Am J Roentgenol 1985; 144 (01) 9-18
  • 34 Baumann MH, Strange C, Heffner JE. et al; AACP Pneumothorax Consensus Group. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001; 119 (02) 590-602
  • 35 Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. Am J Roentgenol 1992; 159 (01) 29-33
  • 36 Hirsch JH, Rogers JV, Mack LA. Real-time sonography of pleural opacities. AJR Am J Roentgenol 1981; 136 (02) 297-301
  • 37 Wernecke K. Sonographic features of pleural disease. AJR Am J Roentgenol 1997; 168 (04) 1061-1066
  • 38 Lynch DA, Gamsu G, Aberle DR. Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases. Radiographics 1989; 9 (03) 523-551
  • 39 Copley SJ, Wells AU, Rubens MB. et al. Functional consequences of pleural disease evaluated with chest radiography and CT. Radiology 2001; 220 (01) 237-243
  • 40 Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open access emergency medicine: OAEM 2012; 4: 31
  • 41 Görg C, Restrepo I, Schwerk WB. Sonography of malignant pleural effusion. Eur Radiol 1997; 7 (08) 1195-1198
  • 42 Qureshi NR, Rahman NM, Gleeson FV. Thoracic ultrasound in the diagnosis of malignant pleural effusion. Thorax 2009; 64 (02) 139-143
  • 43 Leung AN, Müller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. Am J Roentgenol 1990; 154 (03) 487-492