State-of-the-art: Radiological investigation of pleural disease

Area of Science:

• Radiology
• Pulmonology
• Thoracic Imaging

Background:

• Pleural diseases, including effusion, thickening, masses, and pneumothorax, are common clinical challenges.
• Accurate diagnosis and management of pleural conditions rely heavily on effective radiological investigation.

Purpose of the Study:

• To review and summarize the benefits and applications of various imaging modalities for pleural disease.
• To provide an updated evidence-based overview of selecting appropriate imaging techniques.

Main Methods:

• Review of conventional chest radiography (CXR) as the initial diagnostic tool.
• Evaluation of advanced imaging modalities: thoracic ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET/CT).

Main Results:

• CXR is the standard initial investigation for suspected pleural disease.
• US is valuable for pleural fluid, nodularity, and point-of-care pneumothorax assessment, though operator-dependent.
• CT is optimal for characterizing pleural thickening, effusions, and masses, including fatty or calcified components.
• MRI offers specific utility for soft tissue abnormalities and serial imaging in younger patients.
• MRI and PET/CT provide prognostic and therapeutic response data for malignant pleural disease.

Conclusions:

• Appropriate selection of imaging modality is critical for effective diagnosis and management of pleural diseases.
• Each imaging technique offers unique advantages, contributing to a comprehensive diagnostic and therapeutic strategy.
• This review highlights the evolving role and evidence supporting different radiological approaches to pleural pathology.