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Pleural ultrasound
Last reviewed: 04.07.2025
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Indications for ultrasound examination of the pleural cavities
Echography will help to identify fluid in the pleural cavity and to determine the location of small accumulations of fluid if aspiration is necessary. If the radiographic examination has confirmed the presence of fluid in the pleural cavities, then echography is indicated only if aspiration under control is necessary in the presence of limited effusion or with a small effusion.
There is no need to perform every pleural puncture under ultrasound guidance.
Preparation
- Patient preparation. No patient preparation is required.
- Patient position. If possible, the patient should be examined in a comfortable sitting position. Apply the gel randomly to the lower chest on the side to be examined.
- Probe selection. Use a 3.5 MHz probe. Use a 5 MHz probe for children and thin adults. Choose the smallest possible probe diameter for scanning the intercostal spaces. If only a large probe is available, the shadows from the ribs will be superimposed on the image, but the necessary information can still be obtained.
- Adjusting the sensitivity of the device. Set the sensitivity level to obtain the optimal image.
Scanning technique
The sensor is installed on the intercostal spaces perpendicular to the patient's skin. In this case, anechoic fluid can be visualized above the diaphragm in the pleural cavities. The lungs have high echogenicity, since they contain air.
First scan the suspicious area and compare with the radiographic data; then scan at all levels, since the effusion may be circumscribed and not visible in the lowest parts of the pleural cavities (in the costophrenic sinus). Change the patient's position to determine the fluid shiftability.
Pleural fluid is hypoechoic or moderately echogenic, and thick septa are sometimes seen. Thin blood and pus are also anechoic, but septa may reflect. It is not always possible to differentiate fluid from solid masses in the pleura or peripheral lungs. Rotate the patient and repeat the examination. Fluid will move, even if there are septa or a large amount of fluid. Peripheral lung tumors or pleural tumors will not move. Aspiration biopsy is necessary to confirm the diagnosis.