Ultrasonography in complete chest X-ray opacification of hemithorax

To assess whether ultrasonography is valuable in the diagnosis and management of patients with complete chest X-ray opacification of hemithorax, chest ultrasonography was conducted in 65 patients. There were 54 patients (83.1%) with massive pleural effusion with or without other pathology, six (9.2%) with tumors, two (3.1%) with organized fibrothorax, two (3.1%) with consolidation or atelectasis and one (1.5%) with pseudocyst of the pleura in the sonographic diagnosis. Sonography differentiated effusion from tumor, consolidation and fibrosis. The effusion showed a hypoechoic area with floating fibrin strands and changed shape on respiration. The tumor revealed a homogeneous iso- or hypoechoic mass with a sharp margin. Consolidation or atelectasis showed a lobar or segmental area of heterogeneous isoechoic density with air-bronchogram. The pleural showed an area of hypoechoic density without floating fibrin or a changed shape on respiration. In 24 (37%) patients we could demonstrate complex pathology addition to the pleural effusion. Twenty-one patients had a hidden tumor beneath the effusion. Three patients had consolidation or atelectasis with effusion. In 13 patients, aspiration biopsy was performed under ultrasonic guidance from the tumor and the histological diagnosis was confirmed in 12 patients. We conclude that ultrasonography is a very useful, noninvasive tool in the differential diagnosis of complete chest X-ray opacification of hemithorax. Complex pathology is also easily detected by sonography. Sonographic findings can also be used as a guideline for an appropriate approach to the patient's management.