Ultrasound in the diagnosis of the juxta-pleural lesion

Any opacity on a chest radiograph has a wide differential diagnosis. Plain radiography and computed tomography may help to differentiate whether bone, intercostal soft tissue or mediastinum are involved. Bronchoscopy is often negative with peripheral lesions. This leaves the physician with a diagnostic problem. We examined ultrasonically 30 patients with juxta-pleural lesions and performed cutting biopsy in 27. Twenty-four of these produced positive histology (90%). The three that were not biopsied were anechoic and had pulsatile lesions due to vascular abnormalities. There were four benign lesions all with hypoechoic appearances and the 20 malignant cases showed a wide spectrum of echogenicity. Of the malignant lesions, 90% showed pleural line disruption with reduced respiratory movement suggesting chest wall invasion. There were no complications, despite using cutting biopsy.