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Background   Thoracic ultrasound is an essential tool in the daily clinical care of pleural effusions and especially parapneumonic pleural effusions (PPEs), in terms of diagnosis, management, and follow-up. Hypoechogenicity index (HI) is a quantitative marker of pleural fluid echogenicity. We aimed to examine associations of HI with pleural inflammation in patients with PPE.Methods   All patients included underwent a thoracic ultrasound with HI determination at the first day of their admission for a PPE. Thoracentesis was performed in all patients. Demographics, laboratory measurements, and clinical data were collected prospectively and recorded in all subjects.Results   Twenty-four patients with PPE were included in the study. HI was statistically significantly correlated with intensity of inflammation as suggested by pleural fluid LDH ( p  < 0.001,  r  = −0.831), pleural fluid glucose ( p =0.022,  r  = 0.474), and pleural fluid pH ( p  < 0.001,  r  = 0.811). HI was correlated with ADA levels ( p =0.005,  r  = −0.552). We observed a statistically significant correlation of HI with pleural fluid total cell number ( p  < 0.001,  r  = −0.657) and polymorphonuclears percentage ( p =0.02,  r  = −0.590), as well as days to afebrile ( p =0.046,  r  = −0.411), duration of chest tube placement ( p  < 0.001,  r  = −0.806), and days of hospitalization ( p =0.013,  r  = −0.501).  Discussion . HI presents a fast, easily applicable, objective, and quantitative marker of pleural inflammation that reliably reflects the intensity of pleural inflammation and could potentially guide therapeutic management of PPE.

The Use of a Novel Quantitative Marker of Echogenicity of Pleural Fluid in Parapneumonic Pleural Effusions