{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T22:48:43Z","timestamp":1785278923482,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T00:00:00Z","timestamp":1601856000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Respiratory Journal"],"published-print":{"date-parts":[[2020,10,5]]},"abstract":"<jats:p>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 (<jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>&lt;<\/a:mo>\n                        <a:mn>0.001<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>, r\u2009=\u2009\u22120.831), pleural fluid glucose (<jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>0.022<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>, r\u2009=\u20090.474), and pleural fluid pH (<jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>p<\/e:mi>\n                        <e:mo>&lt;<\/e:mo>\n                        <e:mn>0.001<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>, r\u2009=\u20090.811). HI was correlated with ADA levels (<jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mi>p<\/g:mi>\n                        <g:mo>=<\/g:mo>\n                        <g:mn>0.005<\/g:mn>\n                     <\/g:math>\n                  <\/jats:inline-formula>, r\u2009=\u2009\u22120.552). We observed a statistically significant correlation of HI with pleural fluid total cell number (<jats:inline-formula>\n                     <i:math xmlns:i=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\">\n                        <i:mi>p<\/i:mi>\n                        <i:mo>&lt;<\/i:mo>\n                        <i:mn>0.001<\/i:mn>\n                     <\/i:math>\n                  <\/jats:inline-formula>, r\u2009=\u2009\u22120.657) and polymorphonuclears percentage (<jats:inline-formula>\n                     <k:math xmlns:k=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\">\n                        <k:mi>p<\/k:mi>\n                        <k:mo>=<\/k:mo>\n                        <k:mn>0.02<\/k:mn>\n                     <\/k:math>\n                  <\/jats:inline-formula>, r\u2009=\u2009\u22120.590), as well as days to afebrile (<jats:inline-formula>\n                     <m:math xmlns:m=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M7\">\n                        <m:mi>p<\/m:mi>\n                        <m:mo>=<\/m:mo>\n                        <m:mn>0.046<\/m:mn>\n                     <\/m:math>\n                  <\/jats:inline-formula>, r\u2009=\u2009\u22120.411), duration of chest tube placement (<jats:inline-formula>\n                     <o:math xmlns:o=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M8\">\n                        <o:mi>p<\/o:mi>\n                        <o:mo>&lt;<\/o:mo>\n                        <o:mn>0.001<\/o:mn>\n                     <\/o:math>\n                  <\/jats:inline-formula>, r\u2009=\u2009\u22120.806), and days of hospitalization (<jats:inline-formula>\n                     <q:math xmlns:q=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M9\">\n                        <q:mi>p<\/q:mi>\n                        <q:mo>=<\/q:mo>\n                        <q:mn>0.013<\/q:mn>\n                     <\/q:math>\n                  <\/jats:inline-formula>, r\u2009=\u2009\u22120.501). 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.<\/jats:p>","DOI":"10.1155\/2020\/1283590","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T01:30:57Z","timestamp":1601947857000},"page":"1-6","source":"Crossref","is-referenced-by-count":6,"title":["The Use of a Novel Quantitative Marker of Echogenicity of Pleural Fluid in Parapneumonic Pleural Effusions"],"prefix":"10.1155","volume":"2020","author":[{"given":"Charalampos","family":"Varsamas","sequence":"first","affiliation":[{"name":"Respiratory Medicine Department, University of Thessaly, School of Medicine, Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Kalkanis","sequence":"additional","affiliation":[{"name":"Louvain University Center for Sleep and Wake Disorders, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos I.","family":"Gourgoulianis","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, University of Thessaly, School of Medicine, Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7595-6715","authenticated-orcid":true,"given":"Foteini","family":"Malli","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Department, University of Thessaly, School of Medicine, Larissa, Greece"},{"name":"Respiratory Disorders Lab, Nursing Department, University of Thessaly, Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1111\/crj.12941"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1012740"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-016-9964-2"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1080\/17476348.2017.1300531"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.136978"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1590\/s1806-37132014000100002"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1159\/000330920"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.03.31"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.70.3.328"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.138.9.1378"},{"key":"11","volume-title":"Pleural Diseases","author":"R. 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