Which imaging modalities are recommended for the initial assessment of suspected pleural disease in primary care?

For the initial assessment of suspected pleural disease in primary care, the recommended imaging modality is a chest X-ray. This is the first-line investigation to identify pleural abnormalities and to exclude other thoracic pathologies. Chest X-ray should be offered urgently, especially in patients aged 40 and over with symptoms or signs suggestive of pleural disease, such as unexplained chest pain, shortness of breath, or chest signs consistent with pleural involvement. The chest X-ray can help detect pleural effusions, thickening, or masses that warrant further specialist evaluation ¹,².

While chest X-ray remains the primary imaging tool in primary care, computed tomography (CT) of the thorax is considered a more detailed imaging modality and is typically reserved for secondary care or specialist assessment. CT provides superior anatomical detail and can better characterize pleural abnormalities, guide biopsy, and assess the extent of disease, but it is not routinely used as the initial test in primary care due to availability and cost considerations ¹[(Hallifax et al., 2017)].

Ultrasound imaging may also be used in secondary care to evaluate pleural fluid and guide thoracentesis but is not generally part of the initial primary care assessment ¹[(Hallifax et al., 2017)].

In summary, an urgent chest X-ray is the recommended initial imaging modality for suspected pleural disease in primary care, with CT thorax reserved for further evaluation in secondary care settings.