Point of Care Ultrasound for the General Internist: Pleural Effusions

Pleural effusions are a common finding in many clinical settings and have important diagnostic and therapeutic implications. They may be identified by physical exam, chest radiography, chest computerized tomography (CT) scans or point of care ultrasonography (POCUS). The use of POCUS for the diagnosis and management of pleural effusions offers several advantages relevant to the practice of the general internist. For the diagnosis of pleural effusion, POCUS has superior sensitivity and specificity when compared to chest radiography and physical exam. Abnormal sonographic features of the pleural fluid and the adjacent pleura may suggest the presence of an exudative or malignant effusion. POCUS can be used to quickly estimate the size of a pleural effusion. Lastly, the use of ultrasound guidance when performing a thoracentesis reduces the risk of pneumothorax and hemorrhage.