Skip to main content

Can chest ultrasonography differentiate between benign and malignant effusions?



The differential diagnosis of exudative pleural effusion is a major challenge for chest physicians particularly in a country with limited financial resources.


The aim of this study was to evaluate the role of the sonographic features in the prediction of exudative malignant pleural effusion.


This was a prospective cross-sectional study.


This study was carried out between May 2013 and June 2014 in the Chest Department of Assiut University Hospital.


The patients enrolled included 25 patients with malignant pleural effusion and 25 patients with other different benign causes.

Main outcome measures

The sonographic appearances of pleural effusions were defined in terms of five patterns: anechoic, complex septated, complex nonseptated, pleural thickening, and pleural nodules.


Among the 25 malignant exudative pleural effusions, a complex nonseptated pattern is a useful diagnostic predictor, with sensitivity, specificity, positive predictive value, and negative predictive value of 60, 68, 65, and 63%, respectively. Pleural nodules were only found in malignant effusion (100% specificity). If we define the complex septated sonographic pattern as a predictor for benign effusion, we can achieve sensitivity, specificity, positive predictive value, and negative predictive value of 52, 88, 81, and 65%, respectively.


Pleural nodules and a complex nonseptated pattern in the sonographic appearance are useful predictors of malignant pleural effusions, whereas a complex septated pattern is a useful predictor in nonmalignant effusion.


  1. Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003; 58 Suppl 2:8–17.

    Article  Google Scholar 

  2. Ocaña I, Martinez-Vazquez JM, Segura RM, Fernandez-De-Sevilla T, Capdevila JA. Adenosine deaminase in pleural fluids. Test for diagnosis of tuberculous pleural effusion. Chest 1983; 84:51–53.

    Article  Google Scholar 

  3. Hiraki A, Aoe K, Eda R, Maeda T, Murakami T, Sugi K, Takeyama H. Comparison of six biological markers for the diagnosis of tuberculous pleuritis. Chest 2004; 125:987–989.

    Article  Google Scholar 

  4. Beckh S, Bölcskei PL, Lessnau KD. Real-time chest ultrasonography: a comprehensive review for the pulmonologist. Chest 2002; 122:1759–1773.

    Article  Google Scholar 

  5. Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. Am J Roentgenol 1992; 159:29–33.

    Article  CAS  Google Scholar 

  6. Tu CY, Hsu WH, Hsia TC, Chen HJ, Tsai KD, Hung CW, Shih CM. Pleural effusions in febrile medical ICU patients: chest ultrasound study. Chest 2004; 126:1274–1280.

    Article  Google Scholar 

  7. Chian CF, Su WL, Soh LH, Yan HC, Perng WC, Wu CP. Echogenic swirling pattern as a predictor of malignant pleural effusions in patients with malignancies. Chest 2004; 126:129–134.

    Article  Google Scholar 

  8. Reuss J. The pleura. In: Mathis G, Lessnau KD, eds. Atlas of chest sonography. 1st ed. Berlin, Germany: Springer; 2003:17–35.

    Chapter  Google Scholar 

  9. Chung CL, Chen YC, Chang SC. Effect of repeated thoracenteses on fluid characteristics, cytokines, and fibrinolytic activity in malignant pleural effusion. Chest 2003; 123:1188–1195.

    Article  Google Scholar 

  10. Carazo Martínez O, Vargas Serrano B, Rodríguez Romero R. Real-time ultrasound evaluation of tuberculous pleural effusions. J Clin Ultrasound 1989; 17:407–410.

    Article  Google Scholar 

  11. Chen KY, Liaw YS, Wang HC, Luh KT, Yang PC. Sonographic septation: a useful prognostic indicator of acute thoracic empyema. J Ultrasound Med 2000; 19:837–843.

    Article  CAS  Google Scholar 

  12. Lee CH, Wang WJ, Lan RS, Tsai YH, Chiang YC. Corticosteroids in the treatment of tuberculous pleurisy. A double-blind, placebo-controlled, randomized study. Chest 1988; 94:1256–1259.

    Article  CAS  Google Scholar 

  13. Light RW, Erozan YS, Ball WC Jr. Cells in pleural fluid. Their value in differential diagnosis. Arch Intern Med 1973; 132:854–860.

    Article  CAS  Google Scholar 

  14. Philip-Joët F, Alessi MC, Philip-Joët C, Aillaud M, Barriere JR, Arnaud A. Juhan-Vague I Fibrinolytic and inflammatory processes in pleural effusions. Eur Respir J 1995; 8:1352–1356.

    Article  Google Scholar 

  15. Hua CC, Chang LC, Chen YC, Chang SC. Proinflammatory cytokines and fibrinolytic enzymes in tuberculous and malignant pleural effusions. Chest 1999; 116:1292–1296.

    Article  CAS  Google Scholar 

  16. Qureshi NR, Rahman NM, Gleeson FV. Thoracic ultrasound in the diagnosis of malignant pleural effusion. Thorax 2009; 64:139–143.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Wafaa A. Hassan MD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hassan, W.A., Alkarn, A.F. & Kamel, M. Can chest ultrasonography differentiate between benign and malignant effusions?. Egypt J Bronchol 9, 165–169 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • malignant effusion
  • pleural nodules
  • septations
  • sonography