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Updated: Aug 8, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Prevalence and clinical significance of pleural microbubbles in computed tomography of thoracic empyema
A Smolikov1, R Smolyakov, K Riesenberg
1Radiology Institute, Soroka University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Aim:
To determine the prevalence and clinical significance of pleural microbubbles in thoracic empyema.
Materials And Methods:
The charts of 71 consecutive patients with empyema were retrospectively reviewed for relevant demographic, laboratory, microbiological, therapeutic and outcome data. Computed tomography (CT) images were reviewed for various signs of empyema as well as pleural microbubbles. Two patient groups, with and without microbubbles were compared.
Results:
Mean patient age was 49 years and 72% were males. Microbubbles were detected in 58% of patients. There were no significant differences between patients with and without microbubbles in regard to pleural fluid chemistry. A causative organism was identified in about 75% of cases in both. There was no difference in the rates of pleural thickening and enhancement, increased extra-pleural fat attenuation, air-fluid levels or loculations. Microbubbles were diagnosed after a mean of 7.8 days from admission. Thoracentesis before CT was performed in 90 and 57% of patients with and without microbubbles (p=0.0015), respectively. Patients with microbubbles were more likely to require repeated drainage (65.9 versus 36.7%, p=0.015) and surgical decortication (31.7 versus 6.7%, p=0.011). Mortalities were 9.8 and 6.6% respectively (p=0.53).
Conclusion:
Pleural microbubbles are commonly encountered in CT imaging of empyema but have not been systematically studied to date. Microbubbles may be associated with adverse outcome such as repeated drainage or surgical decortication. The sensitivity and specificity of this finding and its prognostic implications need further assessment.
Insights
Pleural microbubbles are common in thoracic empyema CT scans. This finding may indicate a need for repeated drainage or surgical decortication in patients with empyema.
Area of Science:
- Pulmonary Medicine
- Radiology
- Thoracic Surgery
Background:
- Thoracic empyema is a serious infection of the pleural space.
- The role of specific imaging findings, such as pleural microbubbles on CT, in predicting empyema outcomes is not well-defined.
Purpose of the Study:
- To investigate the prevalence of pleural microbubbles in patients with thoracic empyema.
- To assess the clinical significance and prognostic implications of pleural microbubbles detected on computed tomography (CT) scans.
Main Methods:
- Retrospective review of 71 patients diagnosed with empyema.
- Analysis of demographic, laboratory, microbiological, therapeutic, and outcome data.
- Detailed review of CT images to identify pleural microbubbles and other empyema signs, comparing patients with and without microbubbles.
Main Results:
- Pleural microbubbles were detected in 58% of empyema patients.
- No significant differences in pleural fluid chemistry or causative organisms were observed between groups.
- Patients with microbubbles showed higher rates of repeated drainage (65.9% vs. 36.7%) and surgical decortication (31.7% vs. 6.7%).
Conclusions:
- Pleural microbubbles are frequently observed in CT imaging of thoracic empyema.
- The presence of microbubbles may be associated with more complicated disease courses, requiring interventions like repeated drainage or decortication.
- Further research is needed to establish the sensitivity, specificity, and definitive prognostic value of pleural microbubbles in empyema.
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