Workup of Pleural Effusion or Pleural Disease MRI Chest Without and With IV Contrast There is no relevant literature to support the use of MRI chest without and with IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. Incidental pleural effusions have been reported in a minority of patients undergoing MRI with contrast for dyspnea, cough, or chest pain. For example, 6.6% (34/514) of patients had a moderate or large pleural effusion on contrast-enhanced MRA ordered for pulmonary embolism evaluation [59], and 4.3% (17/399) patients had a pleural effusion on stress cardiac MRI for possible acute coronary syndrome [60]. MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest without IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. Radiography Chest Consensus recommendations endorse chest radiography as the initial imaging modality for patients with suspected noninfectious pleural effusion [7,61]; however, there are limited empiric data to support these recommendations. US Chest Identification of a pleural effusion for possible US-guided thoracentesis is currently the primary reason for chest US [32]. Chest US is increasingly used as part of the diagnostic pathway for patients in the emergency department [62] and in the intensive care setting [63]. A recent meta-analysis found that chest US had a pooled sensitivity of 91% (95% CI, 83%-96%) and specificity of 92% (95% CI, 82%-97%) using CT as the reference standard for identification of pleural effusion in patients in the intensive care unit [63]. Adding chest US to the conventional diagnostic pathway has been shown to reduce the time to final diagnosis in the emergency department in patients with infectious and noninfectious causes of dyspnea [64]. Variant 4: Pleural effusion incidentally detected on incomplete thoracic imaging study. Next imaging study.
Workup of Pleural Effusion or Pleural Disease. Workup of Pleural Effusion or Pleural Disease MRI Chest Without and With IV Contrast There is no relevant literature to support the use of MRI chest without and with IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. Incidental pleural effusions have been reported in a minority of patients undergoing MRI with contrast for dyspnea, cough, or chest pain. For example, 6.6% (34/514) of patients had a moderate or large pleural effusion on contrast-enhanced MRA ordered for pulmonary embolism evaluation [59], and 4.3% (17/399) patients had a pleural effusion on stress cardiac MRI for possible acute coronary syndrome [60]. MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest without IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. Radiography Chest Consensus recommendations endorse chest radiography as the initial imaging modality for patients with suspected noninfectious pleural effusion [7,61]; however, there are limited empiric data to support these recommendations. US Chest Identification of a pleural effusion for possible US-guided thoracentesis is currently the primary reason for chest US [32]. Chest US is increasingly used as part of the diagnostic pathway for patients in the emergency department [62] and in the intensive care setting [63]. A recent meta-analysis found that chest US had a pooled sensitivity of 91% (95% CI, 83%-96%) and specificity of 92% (95% CI, 82%-97%) using CT as the reference standard for identification of pleural effusion in patients in the intensive care unit [63]. Adding chest US to the conventional diagnostic pathway has been shown to reduce the time to final diagnosis in the emergency department in patients with infectious and noninfectious causes of dyspnea [64]. Variant 4: Pleural effusion incidentally detected on incomplete thoracic imaging study. Next imaging study.