BMJ  2007;334:206-207 (27 January), doi:10.1136/bmj.39061.503866.0B

Practice

Rational imaging

Investigating suspected malignant pleural effusion

¹ Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford OX3 7LJ, ² Radiology Department, Churchill Hospital

The first 150 words of the full text of this article appear below.

Introduction

Learning points Large unilateral pleural effusions are most often caused by malignancy; diagnostic pleural aspiration has a sensitivity of 60% for malignancy If pleural fluid cytology is negative, computed tomography of the chest should be done before the effusion is drained; this has a high sensitivity for malignant pleural disease Pleural fluid should initially be drained only for symptomatic relief; leaving some fluid in the pleural cavity allows the choice of a safe image guided biopsy or thoracoscopy Computed tomography guided biopsy and thoracoscopy (which can be done under conscious sedation by a physician) have high diagnostic yields for malignant pleural disease Computed tomography guided biopsy should be used when pleural thickening is present, with only a small volume of pleural fluid, or when thoracoscopy is not available Thoracoscopy should be used when a substantial amount of pleural fluid remains, if no nodularity is identified on chest computed tomography, and where both . . . [Full text of this article]

The patient

What should be the next investigation?

Outcome

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