. 2020 Jun 11;S0012-3692(20)31660-3.
doi: 10.1016/j.chest.2020.05.583. Online ahead of print.
First Detection of SARS-CoV-2 by Real-Time Reverse-Transcriptase-Polymerase-Chain-Reaction (RT-PCR) Assay in Pleural Fluid

Federico Mei 1 , Martina Bonifazi 2 , Stefano Menzo 3 , Alessandro Di Marco Berardino 4 , Michele Sediari 4 , Luca Paolini 4 , Antonina Re 4 , Francesca Gonnelli 4 , Martina Grilli 4 , Giacomo Spurio Vennarucci 4 , Maria Agnese Latini 4 , Lina Zuccatosta 4 , Stefano Gasparini 2

AffiliationsFree PMC article


COVID-19 is a pandemic infection due to a novel coronavirus (SARS-CoV-2) spreading, resulting in a wide range of clinical features, from asyntomatic carriers to acute respiratory distress syndrome. The gold standard for diagnosis is nucleic acid detection by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) in naso-pharyngeal swabs, but, due to limitations in its sensitivity, thoracic imaging plays a crucial, complementary role in diagnostic work-up and it allows also to reveal atypical findings and potential alternative target for sampling, such as pleural effusion. Although not common, pleural involvement has been described in a minority of patients. Here, we describe the first case of SARS-CoV-2 RT-PCR detection in pleural fluid obtained by means of ultrasound-guided thoracentesis and report its main characteristics. Pleural effusion is not a common finding in COVID-19 infection, but a prompt recognition of this potential localization may be useful to optimize diagnostic work-up as well as management of these patients.

Keywords: computed tomography-guided biopsy; diagnostic yield; meta-analysis; pleural lesions; safety; ultrasound-guided biopsy.