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Point-of-Care Lung Ultrasound in Adults: Image Acquisition
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Quantitative Pleural Fluid Echogenicity for Differentiating Transudative From Exudative Pleural Effusions.

Alaa A El-Dakkak1, Mona El-Hoshy1, Maged Hassan1

  • 1Pulmonology Department, Faculty of Medicine, Alexandria University, Alexandria, EGY.

Cureus
|December 22, 2025
PubMed
Summary

A novel index, pleural fluid relative echogenicity (PFRE), can differentiate between transudative and exudative pleural effusions using thoracic ultrasonography. This non-invasive method shows moderate accuracy in distinguishing effusion types.

Keywords:
echogenicityexudatespleural effusionthoracic ultrasoundtransudates

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Area of Science:

  • Medical Imaging
  • Diagnostic Ultrasound
  • Pulmonology

Background:

  • Thoracic ultrasonography (TUS) is more sensitive than chest radiography for identifying pleural fluid.
  • Differentiating between transudates and exudates is crucial for patient management.
  • Current methods rely on invasive procedures or less sensitive imaging techniques.

Purpose of the Study:

  • To assess the efficacy of a novel index, pleural fluid relative echogenicity (PFRE), in non-invasively differentiating exudates from transudates.
  • To evaluate the quantitative estimation of pleural effusion echogenicity using TUS.
  • To compare PFRE with biochemical markers and Light's criteria.

Main Methods:

  • 140 patients with pleural effusion were recruited.
  • TUS images were analyzed to quantify echogenicity using a novel index (PFRE), comparing pleural fluid to liver echogenicity.
  • PFRE was evaluated for its predictive ability against Light's criteria.

Main Results:

  • PFRE was significantly different between transudates (median 0.26) and exudates (median 0.55) (p<0.001).
  • PFRE showed a positive correlation with effusion protein and a negative correlation with glucose levels.
  • The area under the curve (AUC) for PFRE was 0.77, with a cut-off of ≤0.236 demonstrating 47.73% sensitivity and 90.62% specificity for transudative effusion.

Conclusions:

  • Pleural fluid relative echogenicity (PFRE) offers a non-invasive method for differentiating between transudative and exudative pleural effusions.
  • The TUS-based PFRE index demonstrates moderate accuracy in distinguishing effusion types.
  • This quantitative approach may aid in clinical decision-making for pleural effusions.