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A Pleural Effusion Model in Rats by Intratracheal Instillation of Polyacrylate/Nanosilica
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Does this patient have a pleural effusion?

Camilla L Wong1, Jayna Holroyd-Leduc, Sharon E Straus

  • 1Division of Geriatrics, University of Toronto, and St Michael's Hospital, Toronto, Ontario, Canada.

JAMA
|January 22, 2009
PubMed
Summary
This summary is machine-generated.

Physical examination can help diagnose pleural effusion. Dullness to percussion strongly suggests effusion, while absent tactile fremitus makes it less likely, potentially avoiding unnecessary chest X-rays.

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Area of Science:

  • Pulmonology
  • Diagnostic Accuracy
  • Clinical Examination

Background:

  • Pleural effusion is a frequent condition in patients with respiratory symptoms.
  • The diagnostic utility of bedside physical examination for pleural effusion remains uncertain.

Purpose of the Study:

  • To systematically review existing evidence on the accuracy of physical examination techniques in assessing the likelihood of pleural effusion.

Main Methods:

  • Searched MEDLINE and EMBASE databases (1950-2008) for English-language, prospective diagnostic accuracy studies.
  • Included studies comparing physical examination maneuvers against radiographic confirmation of pleural effusion.
  • Extracted data on study quality, participant recruitment, reference standards, and diagnostic test accuracy.

Main Results:

  • Five prospective studies (934 patients) met the inclusion criteria.
  • Dullness to conventional percussion demonstrated the highest accuracy (positive likelihood ratio: 8.7).
  • Absence of reduced tactile vocal fremitus indicated a lower likelihood of pleural effusion (negative likelihood ratio: 0.21).

Conclusions:

  • Dullness to percussion and tactile fremitus are key physical findings for pleural effusion.
  • Dull percussion increases the probability of effusion, necessitating chest radiography for confirmation.
  • Absence of reduced tactile fremitus may preclude the need for chest radiography in low-probability cases.