[Assessment of the pleural cavity with ultrasound and pleurography]

High resolution ultrasonography and ultrasonography guided needle aspiration (UGNA) are useful for the evaluation of pleural lesions. We applied the technique of UGNA for pleurography and were able to see the configuration of the pleural surface and space under physiological conditions. Here we show how these newly developed methods of pleurography and ultrasonography can be used to evaluate changes in pleural configuration and pleural involvement of bronchogenic carcinoma. Newly developed pleurography: A catheter was inserted into the narrow pleural space without making a pneumothorax. After infusion of contrast medium (0.5-1 ml/kg), pleural indentation, adhesions, bullous changes, and partial fusion of lobes were clearly visible. This pleurography is especially useful for the diagnosis of tumor invasion into the pleura and chest wall when the tumor is adjacent to the pleura. Detection of latent malignant pleurisy: Small effusions were detected by ultrasonography in 10% of patients with bronchogenic carcinoma who had no pleural effusion on chest roentgenogram. After UGNA, malignant cells were found in 35% in these tiny effusions (4% of the total). To more accurately assess latent malignant pleurisy, we now perform lavage of the pleural space with 50 ml of saline during pleurography before deciding on surgical treatment.