The Role of Thoracic Ultrasound in the Identification and Characterization of Pleural Effusion: A Literature Review

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Published Sep 23, 2026
https://doi.org/10.70436/nuijb.v5i02.481
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Vol. 5 No. 02 (2026): April

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Sayed Azizullah Hashimi
Nangarhar University
https://orcid.org/0009-0000-0723-1133
Nasimullah Rahmatzai
Nangarhar University
https://orcid.org/0009-0009-9520-8384

Abstract

Pleural effusion is a common clinical condition characterized by abnormal fluid accumulation within the pleural cavity and is associated with numerous cardiopulmonary and systemic diseases. This literature review evaluates the role of thoracic ultrasound in the detection, characterization, and management of pleural effusion. Relevant studies were identified through searches of PubMed, Scopus, Science Direct, and Medline databases. Evidence demonstrates that thoracic ultrasound has superior sensitivity compared with chest radiography for detecting even small pleural effusions. Sonographic features such as echogenicity, septations, and loculations assist in differentiating transudative and exudative effusions. Ultrasound also plays a critical role in guiding thoracentesis and chest tube insertion, reducing procedural complications and improving patient safety. Compared with computed tomography and conventional radiography, ultrasound offers real-time bedside assessment without radiation exposure. Despite limitations related to operator dependency and inability to determine biochemical fluid composition, thoracic ultrasound remains a valuable first-line imaging modality for pleural effusion evaluation. Future advances including contrast-enhanced ultrasound and artificial intelligence-assisted imaging may further improve diagnostic performance.

Keywords

Pleural, effusion, Thoracic, ultrasound, Sonography, Thoracentesis, Exudate, Transudate

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Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Author Biographies

Sayed Azizullah Hashimi, Nangarhar University

Radiology Department, Medical Faculty, Nangarhar University, Jalalabad, Afghanistan

Nasimullah Rahmatzai, Nangarhar University

Radiology Department, Medical Faculty, Nangarhar University, Jalalabad, Afghanistan

How to Cite
Hashimi, S. A., & Rahmatzai, N. (2026). The Role of Thoracic Ultrasound in the Identification and Characterization of Pleural Effusion: A Literature Review. Nangarhar University International Journal of Biosciences, 5(02), 1–5. https://doi.org/10.70436/nuijb.v5i02.481

References

  1. Abramowitz Y, Simanovsky N, Goldstein MS, Hiller N. Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 2009;192(3):618–623. doi:10.2214/AJR.08.1286.
  2. Awan MM, Saqib H, Zafar I, Kalsoom F, Amin M. Diagnostic accuracy of point-of-care ultrasound versus chest radiography in pleural effusion: a systematic review and meta-analysis. Pak J Chest Med. 2024;30(2):263–276.
  3. Azoulay E. Pleural effusions in the intensive care unit. Curr Opin Pulm Med. 2003;9(4):291–297. doi:10.1097/00063198-200307000-00008.
  4. Balik M, Plasil P, Waldauf P, Pazout J, Fric M, Otahal M, et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med. 2006;32(2):318–321. doi:10.1007/s00134-005-0024-2.
  5. Burgener FA, Kormano M, Pudas T. Differential Diagnosis in Conventional Radiology. 3rd ed. New York: Thieme; 2008.
  6. Cotton D, Lenz R, Kerr B, Ma IWY. Point-of-care ultrasound for the general internist: pleural effusions. Can J Gen Intern Med. 2018;13(2):22–28. doi:10.22374/cjgim.v13i2.231.
  7. Eibenberger KL, Dock WI, Ammann ME, Dorffner R, Hörmann MF, Grabenwöger F. Quantification of pleural effusions: sonography versus radiography. Radiology. 1994;191(3):681–684. doi:10.1148/radiology.191.3.8184046.
  8. Esmadi M, Lone N, Ahmad DS, et al. Multiloculated pleural effusion detected by ultrasound only in a critically ill patient. Am J Case Rep. 2013;14:63–66. doi:10.12659/AJCR.883816.
  9. Evans PT, Zhang RS, Cao Y, Breslin S, Panebianco N, Baston CM, et al. The use of thoracic ultrasound to predict transudative and exudative pleural effusion. POCUS J. 2021;6(2):97–102. doi:10.24908/pocus.v6i2.15193.
  10. Grimberg A, Shigueoka DC, Atallah AN, Ajzen S, Iared W. Diagnostic accuracy of sonography for pleural effusion: systematic review. Sao Paulo Med J. 2010;128(2):90–95. doi:10.1590/S1516-31802010000200009.
  11. Havelock T, Teoh R, Laws D, Gleeson F; British Thoracic Society Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2)–ii76. doi:10.1136/thx.2010.137026.
  12. Ielo S, Fratini A, Amante E, Spinelli M. Identify the type of pleural effusion with lung ultrasound: a state-of-the-art review. Clin Res J Intern Med. 2023;4(2):504–509.
  13. Islam ZU, Awan MM, Saqib HA, Firdous A, Saeed U. Evaluation of pleurodesis success in malignant pleural effusion using radiologic modalities. Pak J Chest Med. 2024;30(1):93–99.
  14. Connolly JA, Dean AJ, Hoffmann B, et al. Emergency Point-of-Care Ultrasound. Hoboken, NJ: Wiley-Blackwell; 2017.
  15. Ibitoye BO, Idowu BM, Ogunrombi AB, Afolabi BI. Ultrasonographic quantification of pleural effusion: comparison of four formulae. Ultrasonography. 2018;37(3):254–260. doi:10.14366/usg.17050.
  16. Kocijancic I, Vidmar K, Ivanovič-Herceg Z. Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions. J Clin Ultrasound. 2003;31(2):69–74. doi:10.1002/jcu.10141.
  17. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659–1670. doi:10.1378/chest.14-1313.
  18. Lichtenstein DA. Current misconceptions in lung ultrasound: a short guide for experts. Chest. 2019;156(1):21–25. doi:10.1016/j.chest.2019.02.332.
  19. Soni NJ, Franco R, Velez MI, Schnobrich D, Dancel R, Restrepo MI, et al. Ultrasound in the diagnosis and management of pleural effusions. J Hosp Med. 2015;10(12):811–816. doi:10.1002/jhm.2434.
  20. Zaki HA, Albaroudi B, Shaban EE, Shaban A, Elgassim M, Almarri ND, et al. Advancement in pleural effusion diagnosis: a systematic review and meta-analysis of point-of-care ultrasound versus radiographic thoracic imaging. Ultrasound J. 2024;16:3.
  21. doi:10.1186/s13089-023-00356-z.
  22. Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006;73(7):1211–1220.
  23. Light RW. Pleural diseases. 7th ed. Philadelphia, PA: Wolters Kluwer; 2022.
  24. Feller-Kopman D, Light R. Pleural disease. N Engl J Med. 2018;378(8):740–751. doi:10.1056/NEJMra1403503.
  25. Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline. Thorax. 2010;65(Suppl 2)–ii17. doi:10.1136/thx.2010.136978.
  26. Mayo PH, Copetti R, Feller-Kopman D, Mathis G, Maury E, Mongodi S, et al. Thoracic ultrasonography: a narrative review. Intensive Care Med. 2019;45(9):1200–1211. doi:10.1007/s00134-019-05725-8.

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