Contrast-enhanced sonography for differential diagnosis of pleurisy and focal pleural lesions of unknown cause

Chest. 2005 Dec;128(6):3894-9. doi: 10.1378/chest.128.6.3894.


Background: Ultrasound enables the visualization of pleural-based lesions with a poor correlation to specific pathology. At this time, there are no data about the diagnostic value of contrast-enhanced sonography (CES) in pleural lesions.

Methods: From August 2004 to January 2005, 25 consecutive patients with clinical symptoms of pleurisy and focal pleural lesions of unknown origin seen on B-mode ultrasonography were prospectively studied by CES. The lesions were diagnosed as pleuropneumonia (n = 12), pulmonary embolism/infarction (n = 7), malignant lymphoma (n = 2), pleural metastasis (n = 2), granuloma (n = 1), and unknown cause (n = 1). The diagnosis of the lesions was confirmed by contrast-enhanced CT scanning (n = 20), scintigraphy (n = 3), and follow-up (n = 2). Time to the enhancement of the contrast agent was determined. The CES patterns were evaluated during the arterial phase (ie, 2 to 30 s) and the parenchymal phase (ie, 1 to 5 min). The extent of the enhancement of pleural lesions was classified using normal liver tissue as an in vivo reference (absent, hypoechoic, isoechoic, hyperrechoic, or mixed echogenicity).

Results: In 20 patients, an enhancement of the pleural lesion was seen. All 12 patients with pleuropneumonia had a short time to enhancement (between 1 and 6 s), and a marked enhancement (isoechoic/hyperechoic) during the arterial and parenchymal phase. In the remaining 13 patients with other diagnoses than pleuropneumonia, 5 patients had no enhancement and 8 patients had a delayed time to enhancement (> 6 s). The extent of the enhancement was reduced (hypoechoic/anechoic) in 12 of 13 patients during the arterial and parenchymal phases.

Conclusion: In patients with pleurisy and pleural lesions of unknown cause that were found sonographically, CES enables the diagnosis or exclusion of pleuropneumonia.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Contrast Media
  • Diagnosis, Differential
  • Female
  • Humans
  • Image Enhancement*
  • Lymphoma / diagnosis
  • Lymphoma / diagnostic imaging*
  • Male
  • Middle Aged
  • Pleurisy / diagnosis
  • Pleurisy / diagnostic imaging*
  • Pleuropneumonia / diagnosis
  • Pleuropneumonia / diagnostic imaging
  • Prospective Studies
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / diagnostic imaging*
  • Sensitivity and Specificity
  • Ultrasonography, Doppler / methods*


  • Contrast Media