title: Bedside diagnosis and follow-up of patients with pleural effusion by a hand-carried ultrasound device early after cardiac surgery.
abstract: OBJECTIVE
  The aim of this study was to assess the potential value of hand-carried ultrasound (HCU) devices in the diagnosis and follow-up of patients with pleural effusion (PE) after cardiac surgery.
  
  
  METHODS
  Seventy consecutive patients were evaluated at bedside early after cardiac surgery, in the upright sitting position, using an HCU device on hospital admission and every 3 days until hospital discharge. The posterior chest wall was scanned along the paravertebral, scapular, and posterior axillary lines. For each hemithorax, an effusion index was derived as the sum of the intercostal spaces between the lower and upper limits of the PE along the lines of scanning, divided by 3. A standard chest radiograph was performed in all patients on hospital admission and at hospital discharge, and was qualitatively scored (0, absent; 1, small; 2, large PE). The findings of the HCU device and radiograph were compared using kappa statistics and the Kruskal-Wallis test.
  
  
  RESULTS
  A chest ultrasound was feasible in all patients (mean [+/- SD] time, 5 +/- 2 min). Compared with the chest ultrasound, a physical examination showed a sensitivity of 69% and a specificity of 77%. On hospital admission, the HCU device detected a PE in 72 of 140 hemithoraxes. Agreement with the finding of the radiograph was 76% (kappa = 0.52). In 15 hemithoraxes, the HCU device revealed a PE that had not been diagnosed using the radiograph. Conversely, in 18 hemithoraxes a PE that had been diagnosed with a radiograph was not confirmed by the HCU device. The correlation between ultrasound and radiographic scores was statistically significant (p < 0.001). At hospital discharge, a PE was present in 31 of 140 hemithoraxes according to the findings of the HCU device, and in 38 of 140 hemithoraxes according to the findings of the radiograph (agreement, 78%; kappa = 0.44).
  
  
  CONCLUSIONS
  In patients early after cardiac surgery, HCU devices allow rapid PE detection and improve the clinical diagnosis. Compared to a radiograph, this method offers the unique advantage of the bedside evaluation of patients without the need for radiation exposure.
authors.affiliation: Department of Cardiology, Presidio Ospedaliero Integrato Portuense, Rome, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Piccoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Trambaiolo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Salustri
authors.forename: Elena
authors.initials: E
authors.lastname: Cerquetani
authors.forename: Alfredo
authors.initials: A
authors.lastname: Posteraro
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Pastena
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Amici
authors.forename: Federica
authors.initials: F
authors.lastname: Papetti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Marincola
authors.forename: Salvatore
authors.initials: S
authors.lastname: La Carruba
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Gambelli
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D004452:Echocardiography / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D011182:Postoperative Care; D011446:Prospective Studies; D011859:Radiography