DOI: http://dx.doi.org/10.18203/2349-3933.ijam20183147

Profile of exudative pleural effusion in the region of Bhuj people

Vishal K. Desai, Rashmi S. Arora

Abstract


Background: Exudative pleural effusions are a common diagnostic problem in clinical practice, as the list of causes is quite exhaustive, although sometimes they can be inferred from the clinical picture. In the West the most common cause is Para pneumonic effusions followed by malignancy, while in India it is tubercular effusion followed by malignant effusion. Despite the availability of various tests, there is a need for defining the best diagnostic and cost-effective approach to quickly diagnose and treat exudative pleural effusions. The objectives are to conduct a clinical and etiological study of exudative pleural effusion, to evaluate biochemical profile, cytological profile and radiological profiles of exudative pleural effusion.

Methods: Prospective study of 100 patients with exudative pleural effusions. The demographic data was expressed as mean±standard deviation. Comparison between groups was done by Chi-Square test and Fischer exact test for categorical variables and Kruskar-Wallis and Mann-Whitney tests for continuous variables.

Results: There were 67 males and 33 females. The mean age was 41.6±15.74. The majority were tubercular in origin (67%),13%,8%,3%and 6% were malignant effusions, Synpneumonic effusion, pancreatic effusions and empyema respectively. Diagnosis was not established in 3% of effusions. Massive effusions were seen in 53.8% of malignant effusions and 33.3% of empyemas. Most effusions had a total cell count between 1000 to 5000 cells /mm3.Lymphocyte predominant effusions were seen in 84.6% and 89.6% of malignant and tubercular effusions. 61.5% of malignant effusions had a positive cytology. Tubercular effusion had a pleural fluid ADA more than 40 IU/L. 92.3% of malignant effusion had pleural fluid ADA less than 30IU.

Conclusions: Pleural effusion is a commonly encountered in medical practice and in our country, the commonest cause is tuberculosis, as is evidenced from the present study. The initial step in evaluating case of pleural effusion is to establish the cause of pleural effusion which is done by a detailed history, clinical examination and investigations like a chest radiology and pleural fluid analysis. Even in the advanced diagnostic approaches, still detailed clinical history and examination of the patient of the patient is important to make a clinical diagnosis. All suspected cases of pleural effusion should undergo Sonography of the thorax along with routine chest x-ray. Fluid cytology should be done to confirm tuberculosis or to rule out malignancy, which guides the physician for further evaluation of the patient if required.


Keywords


Empyema, Pleural effusion, Tuberculosis

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References


Light R. Anatomy of pleura pleural disease. In: Pleural diseases. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2013.

Light RW. Pleural effusion. New Eng J Med. 2002;346(25):1971-7.

Maldhure, Kulkarni B. Pleural biopsy and adenosine deaminase in the pleural fluid in the diagnosis of tubercular pleural effusion. Ind J Tuberculosis. 1994;41:161-4.

Park. Text book of preventive and social medicine. Epidemiology of Tuberculosis. 23rd ed. Bansarilal publications Park;2005;32:340-4.

Light RW, Establishing the diagnosis of tuberculous pleuritis. Arch Intern Med. 1998;158:1967-8.

Aoki Y, Katoh O, Nakanishi Y, Kuroki S, Yamada H. A comparison of study of gamma interferon, ADA, and CA 125 as the diagnostic parameters in tuberculous pleuritis. Respir Med. 1994;88:139-43.

McKenna JM, Chandrasekhar AJ, Henkin RE. Diagnostic value of CEA in exudative pleural effusions. Chest. 1980;78:587-90.

Alfagem I, Munoz F, Pena N, Umbría S. Empyema of the thorax in adults etiology, microbiology and management. Chest. 1993;103:1502-7.

Storm HKR, Krasnik M, Bang K, Frimodt-Møller N. Treatment of pleural empyema secondary to pneumonia: thoracocentesis regimen versus tube drainage. Thorax. 1992;47:77-81.

Poe RH, Matthew GM, Israel RH, Kallay MC. Utility of decortication in Parapneumonic effusions. Chest. 1991;100:963-7.

Valdes L, Alvarez D, San Jose E, Penela P, Valle JM, García-Pazos JM. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998;158:2017-21.

Berger HW, Mejia E. Tuberculous pleurisy. Chest. 1973;63:88-92.

Epstein DM, Kline LR, Albelda SM, Miller WT. Tuberculous pleural effusions. Chest. 1987;91:106-9.

Aho K, Brander E, Patiala J. Studies for primary drug resistance in tuberculous pleurisy. Scand J Respir Dis. 1968; 63:111-4.

Pathak AK, Bhutan M, Mohan A, Guleria R, Bal S, Kochupillai V. Non-small cell lung cancer, current status and future prospects. Indian J Chest Dis Allied Sci. 2004;46:191-203.

Villegas MV, Labrada LA, Saravia NG. Evaluation of Polymerase chain reaction, Adenosine deaminase, and gamma interferon in the pleural fluid for the differential diagnosis of pleural tuberculosis. Chest. 2000;118:1355-64.

Maher GG, Berger JW. Massive pleural effusions and non-malignant causes in 46 patients. Am Rev Resp Dis. 1972;105:458-60.

Bartlett JG, Gorbach SL, Thadepalli H, Finegold S. Bacteriology of empyema. Lancet. 1974;1:338-40.

Varkey B, Rose HD, Kutty CPK, Politis J. Empyema thoracis during a ten-year period. Arch Intern Med. 1981;141:1771-6.

Fujiwara H, Tsuyuguchi I. Frequency of tuberculin reactive T- lymphocytes in pleural fluid and blood from patients with tuberculous pleurisy. Am Rev Respir Dis. 1986;89:530-2.

Shimokata K, Kawachi H, Kishimoto H, Maeda F, Ito Y. Local cellular immunity in tuberculous pleurisy. Am Rev Respir Dis. 1982;128:822-4.

Bueno CE, Clemente G, Castro BC, Martín LM, Ramos SR, Panizo AG, et al. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Arch Intern Med. 1990;150:1190-4.

Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Use of adenosine deaminase as a diagnostic tool for tuberculous pleurisy. Thorax. 1995;50:672-4.

Roth BJ, O'Meara TF, Cragun WH. The serum effusion albumin gradient in the evaluation of pleural effusions. Chest. 1990;98:546-9.

Spriggs AI, Boddington MM. The cytology of effusions. 2nd Edition New York: Grune & Stratton;1968;2:210-5.

Dekker A, Bupp PA. Cytology of serous effusions: An investigation into the usefulness of cellblocks versus smears. Am J Clinical Path. 1978;70:855-60.

Brook I, Frazier EH. Aerobic and anaerobic microbiology of empyema. A retrospective review in two military hospitals. Chest. 1993;103:1502-7.

Andrews NC, Parker EF, Shaw RR. Management of non-tuberculous empyema. Am Rev Respir Dis. 1962;85:935-6.

Johnston WW. The malignant pleural effusion: a review of cytopathological diagnosis of 584 specimens from 472 consecutive patients. Cancer. 1985;56:905-9.

Dodson WH, Hollingsworth JW. Pleural effusion in rheumatoid arthritis. N Engl J Med. 1966;275:1337-42.

Perez-Rodriguez E, Castro DJ. The use of ADA isoenzymes analysis in pleural effusions: diagnostic role and relevance to the origin of increased in tuberculous pleurisy. Curr Opin. 2000;6:259-66.

Leong SS, Lima CM, Sherman CA, Green MR. The 1997 International staging system for non-small cell lung cancer: have all the issues been addressed? Chest. 1999;115:242-8.

Villena V, Lopez A, Pozo F, Echave-Sustaeta J, Ortuño-de-Solo B, Estenoz-Alfaro J, et al. Interferon gamma levels in the pleural fluid in the diagnosis of tuberculosis. The Am J Med. 2003;115:365-70.

Villena V, Lopez E, Echave-Sustaeta J, Martin-Escribano P, Ortuno-de-Solo B, Estenoz-Alfaro J. Gamma interferon in 388 immunocompromised and immunocompetent patients for the diagnosis of pleural tuberculosis. Euro Resp J. 1996;9:2635-9.

Kataria YP, Imtiaz Kurshid. ADA in the diagnosis of pleural tuberculosis. Chest. 2001;120:334-6.

Baganha MF, Pego A, Lima MA, Gaspar EV, Cordeiro AR. Serum and pleural ADA, correlation with lymphocytic population. Chest. 1990;97:605-10.

Prasad R, Tripathi RP, Mukerji PK, Singh M, Srivastava VM. Adenosine deaminase activity in pleural fluid. Indian J Chest Dis Allied Sci. 1992;34:123-6.

Perez-Rodriguez E, Castro DJ. The use of ADA isoenzymes analysis in pleural effusions: diagnostic role and relevance to the origin of increased in tuberculous pleurisy. Curr Opin. 2000;6:259-66.

Gilhotra R, Seghal,S, Gindal SK. Pleural biopsy and adenosine deaminaseenzyme activity in effusions of different etiologies. Lung India. 1989;3:122-4.

Raj B, Chopra RK, Lal HA, Saini AS, Singh VE, Kumar PA, et al. Adenosine deaminase activity in pleural fluid: adiagnostic aid in tuberculous pleural effusion. Indian J Chest Dis Allied Sci.1985;26:27.

Pranay Kumar S, Sinha BB, Akhouri. Diagnosing tuberculous pleural effusion: sensitivity of mycobacterial culture, histopathology and adenosine deaminase activity. J Assoc Phy India. 1985;33:644-5.

Conde MB, Loivos AC, Rezende VM, Soares SL, Mello FC, Reingold AL, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med. 2003;167:72.