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Swirling pattern in patients with exudative pleural effusion



Thoracic ultrasound is the gold-standard method for studying pleural effusions. It is more sensitive than chest radiography or computed tomography.


The aim of the paper was to determine whether the echogenic swirling pattern identifiable on real-time chest ultrasonographic images is a predictor of malignant pleural effusions.


Medical records of patients undergoing chest ultrasonography in the Chest Department in Kasr Alaini Cairo University Hospital in the period from July 2013 to December 2014 were reviewed retrospectively. Patients with an echogenic swirling pattern in the pleural effusion, or with malignant diseases associated with pleural effusions, whose pleural fluids had been examined cytologically or whose pleural tissues had been examined pathologically, were enrolled in this study. A total of 45 patients were included. Malignant pleural effusions were diagnosed by the presence of malignant cells in the pleural fluid identified by pleural biopsy. The echogenic swirling pattern was defined as numerous echogenic floating particles within the pleural effusion, which swirled in response to respiratory movement or heartbeat.


There was a statistically significant relation between the swirling sign and the diameter, type, and amount of pleural fluid, with P value of 0.001. There was no statistical significance between the swirling sign and each of the diagnosis, whether malignant or nonmalignant, malignant cases either primary or secondary malignancy, and side of effusion.


The presence of the swirling sign is related to the nature and amount of fluid and has no predilection to the diagnosis of the cause of pleural effusion.


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Correspondence to Yasmine H. El Hinnawy MD.

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Kamel, K., Emam, R.H., Almeldin, A.I. et al. Swirling pattern in patients with exudative pleural effusion. Egypt J Bronchol 11, 250–254 (2017).

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