Capabilities of Pleural Cavities Ultrasound Examination in Pleural Empyema Stage Diagnosis

Objective: to improve the treatment results of patients with pleural empyema (PE) by developing a method of empyema stage diagnosing and expanding the indications for VATS. Materials and methods. The treatment results of patients with PE were analyzed. Patients with nonspecific parapneumonic EP stages 1 and 2 (according to the EACTS classification) who underwent VATS were included in the study. Prior to surgery, on the first or second day after admission to the hospital, the patient was subjected to ultrasound examination of the pleural cavities with the diaphragm excursion determination. Diaphragmatic relative mobility was calculated as the ratio of diaphragm excursion on the affected side to the healthy one. Based on the endoscopic picture and the morphological examination of the biopsy material (pleura) results the disease stage was determined. Results. The study included 67 patients with PE (men – 50, women – 17). The first stage of EP was diagnosed in 30 cases (men – 22, women – 8), the second – in 37 (men – 28, women – 9). The mean age was 46.36 ± 14.01 years. It was found that at the first stage the median of diaphragmatic relative mobility – 0.596 (0.444; 0.714) was significantly greater than at the second stage – 0.078 (0.048; 0.118), P < 0.0001. By ROC analysis the sensitivity of the proposed method was found to be 0.933; specificity 0.973; cut point = 0.255; AUC = 0.0977. Conclusions. Determination of the diaphragm relative excursion in patients with EP is characterized by high sensitivity (0.933) and specificity (0.973) in the differential diagnosis of disease stages 1 and 2. The stage 2 recognition allows to establish indications for the use of VATS, enabling the treatment results improvement and reducing the length of hospital stay.