RESEARCH ARTICLE

A Simple Method for Differentiating Complicated Parapneumonic Effusion/ Empyema from Parapneumonic Effusion Using the Split Pleura Sign and the Amount of Pleural Effusion on Thoracic CT Naoki Tsujimoto1‡, Takeshi Saraya1‡*, Richard W. Light2, Yayoi Tsukahara3, Takashi Koide1, Daisuke Kurai1, Haruyuki Ishii1, Hirokazu Kimura4, Hajime Goto1, Hajime Takizawa1

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1 Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo, Japan, 2 Division of Allergy/Pulmonary/Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America, 3 Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan, 4 Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan ‡ Naoki Tsujimoto and Takeshi Saraya are double first authors. * [email protected]

OPEN ACCESS Citation: Tsujimoto N, Saraya T, Light RW, Tsukahara Y, Koide T, Kurai D, et al. (2015) A Simple Method for Differentiating Complicated Parapneumonic Effusion/Empyema from Parapneumonic Effusion Using the Split Pleura Sign and the Amount of Pleural Effusion on Thoracic CT. PLoS ONE 10(6): e0130141. doi:10.1371/journal. pone.0130141 Academic Editor: Luis Seijo, Fundación Jimenez Diaz, SPAIN Received: December 16, 2014 Accepted: May 18, 2015 Published: June 15, 2015 Copyright: © 2015 Tsujimoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: The authors received no specific funding for this work. Competing Interests: The authors have declared that no competing interests exist.

Abstract Background Pleural separation, the “split pleura” sign, has been reported in patients with empyema. However, the diagnostic yield of the split pleura sign for complicated parapneumonic effusion (CPPE)/empyema and its utility for differentiating CPPE/empyema from parapneumonic effusion (PPE) remains unclear. This differentiation is important because CPPE/ empyema patients need thoracic drainage. In this regard, the aim of this study was to develop a simple method to distinguish CPPE/empyema from PPE using computed tomography (CT) focusing on the split pleura sign, fluid attenuation values (HU: Hounsfield units), and amount of fluid collection measured on thoracic CT prior to diagnostic thoracentesis.

Methods A total of 83 consecutive patients who underwent chest CT and were diagnosed with CPPE (n=18)/empyema (n=18) or PPE (n=47) based on the diagnostic thoracentesis were retrospectively analyzed.

Results On univariate analysis, the split pleura sign (odds ratio (OR), 12.1; p

Empyema from Parapneumonic Effusion Using the Split Pleura Sign and the Amount of Pleural Effusion on Thoracic CT.

Pleural separation, the "split pleura" sign, has been reported in patients with empyema. However, the diagnostic yield of the split pleura sign for co...
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