Comparision of Ultrasound and Chest X-Ray in The Detection of Peural Effusion
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Background: Pleural effusion is a frequent clinical condition requiring timely imaging-based diagnosis for appropriate management. Chest X-ray is widely used as an initial investigation, but its ability to detect small-volume or loculated effusions may be limited. Thoracic ultrasound provides bedside, radiation-free, real-time visualization of pleural fluid and may improve detection and volume assessment. Objective: To compare thoracic ultrasound and chest X-ray in the detection and evaluation of pleural effusion among patients with clinically suspected pleural fluid accumulation. Methods: This cross-sectional observational comparative study was conducted at Tahir Hospital, Tandlianwala, Pakistan. Fifty adult patients who underwent both chest X-ray and thoracic ultrasound were included. Demographic data, clinical findings, imaging results, effusion side, and ultrasound-estimated volume were recorded. Data were analyzed using SPSS version 27. Categorical imaging findings were compared using Chi-square analysis, volume relationships were assessed using Pearson correlation, and ultrasound-estimated volume across severity categories was evaluated using one-way ANOVA. Results: The mean age was 36.52 ± 9.37 years. Chest X-ray findings were significantly associated with ultrasound findings (χ² = 6.044, p = 0.049). X-ray-estimated and ultrasound-estimated volumes showed a strong positive correlation (r = 0.953, p < 0.001). Ultrasound-estimated volume increased across mild, moderate, and large effusion categories, with mean volumes of 254.55 ± 41.56 mL, 752.08 ± 110.81 mL, and 1300.00 ± 100.00 mL, respectively; ANOVA showed a significant between-group difference (F = 177.249, p < 0.001). Conclusion: Thoracic ultrasound provided clinically stronger assessment of pleural effusion than chest X-ray, particularly for volume estimation and severity classification. Ultrasound should be considered a valuable first-line or complementary imaging modality for suspected pleural effusion, especially when small-volume fluid, loculation, bedside evaluation, or procedural planning is clinically relevant.
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