Identification of a hemothorax for possible US-guided thoracentesis is the primary reason for chest US [32]. A recent meta-analysis reported chest US had a 60% sensitivity (95% CI, 31%-86%) and a 98% specificity (95% CI, 94%-99%) for traumatic hemothorax [51]. Variant 3: Dyspnea, cough, or chest pain with suspected pleural effusion, noninfectious. Initial imaging. CT Chest With IV Contrast In patients with suspected malignant pleural effusion or suspected unilateral pleural effusion with an increased pretest probability of malignancy, CT chest with IV contrast is recommended [52,53], although this is not limited to patients with dyspnea, cough, or chest pain. Acquiring the CT scan 60 seconds after the contrast bolus improves visualization of pleural abnormalities associated with malignancy [19]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. CT Chest Without IV Contrast There is no relevant literature to support the use of CT chest without IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. Heart failure, liver failure, and renal failure are common noninfectious causes of pleural effusion, and these patients may present with dyspnea, cough, or chest pain and undergo CT chest without IV contrast as part of their diagnostic workup [54,55]. CTA Chest With IV Contrast In patients with dyspnea, cough, or chest pain and suspected noninfectious pleural effusion, CTA chest with IV contrast is typically performed when there is clinical concern for pulmonary embolism [56] or aortopathy [57]. Pleural effusions in these patients are usually small and not associated with adverse clinical outcomes [57,58].
Workup of Pleural Effusion or Pleural Disease. Identification of a hemothorax for possible US-guided thoracentesis is the primary reason for chest US [32]. A recent meta-analysis reported chest US had a 60% sensitivity (95% CI, 31%-86%) and a 98% specificity (95% CI, 94%-99%) for traumatic hemothorax [51]. Variant 3: Dyspnea, cough, or chest pain with suspected pleural effusion, noninfectious. Initial imaging. CT Chest With IV Contrast In patients with suspected malignant pleural effusion or suspected unilateral pleural effusion with an increased pretest probability of malignancy, CT chest with IV contrast is recommended [52,53], although this is not limited to patients with dyspnea, cough, or chest pain. Acquiring the CT scan 60 seconds after the contrast bolus improves visualization of pleural abnormalities associated with malignancy [19]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. CT Chest Without IV Contrast There is no relevant literature to support the use of CT chest without IV contrast in the initial imaging of dyspnea, cough, or chest pain with suspected noninfectious pleural effusion. Heart failure, liver failure, and renal failure are common noninfectious causes of pleural effusion, and these patients may present with dyspnea, cough, or chest pain and undergo CT chest without IV contrast as part of their diagnostic workup [54,55]. CTA Chest With IV Contrast In patients with dyspnea, cough, or chest pain and suspected noninfectious pleural effusion, CTA chest with IV contrast is typically performed when there is clinical concern for pulmonary embolism [56] or aortopathy [57]. Pleural effusions in these patients are usually small and not associated with adverse clinical outcomes [57,58].