Study of 100 cases of pleural effusion with reference to diagnostic approach
Keywords:Pleural effusion, Pleura, Thoracoscopy
Background: Collection of an abnormal quality and quantity of fluid in the pleural cavity is called pleural effusion. In this study an attempt has been made to arrive at the etiological diagnosis of pleural effusion by analysis of history, clinical presentation, biochemical, radiological, cytological and bacteriological methods.
Methods: This study was carried out in the Department of Pulmonary Medicine, B.J. Medical College, Ahmedabad, Gujarat, India. In this study total 100 indoor patients of adult age and either sex were taken. Patients with pleural effusion as determined by clinical and or radiological means, thoracocentesis on who yield a minimum amount of fluid enough to carry out routine test were included in the study. Patients with pleural effusion with non aspirable fluid quantity decided clinically or radiologically, were excluded.
Results: Most of the patients were between the age group of 31-40 years and males (68%). Most of the patients of tuberculous effusion were from younger age group between 21-50 years. Most common symptom was chest pain (72%) followed by fever (62%). Most of cases were tuberculous (62%) followed by malignant (18%). There were 15 patients with undiagnosed pleural effusion, in which, thoracoscopic pleural biopsy was done, among them 9 patients had malignancy and 5 patients had tuberculous pleural effusion.
Conclusions: Most of etiologies for pleural effusion were tuberculosis among young’s and malignancy in older age. Right sided pleural effusion was more common in exudative effusion while bilateral pleural effusion was more common in patients with transudative. Thoracocentesis followed by pleural fluid analysis is the best method to diagnose the underlying etiology. Thoracoscopic pleural biopsy also has good role in undiagnosed pleural effusions.
Anthony Seaton : crofton and Douglas’s Respiratory Disease 5th edition. 2000;43:1152-80.
Harrison’s principles of Internal Medicine 16th edition. 2004;245:1565-9.
Maldhure BR, Bedukar SP, Kulkarni HP, Papinwar SP. Pleural biopsy and adenosine deaminase in pleural fluid for the diagnosis of tuberculous pleural effusion. The Indian Journal of Tuberculosis. 1994;41:161-5.
Kataria YP, Khurshid I. Adenosine deaminase in the diagnosis of tuberculous pleural effusion. Chest. 2001;120(2):334-6.
Hirsch A, Ruffie P, Nebut M. Pleural effusion: laboratory tests in 300 cases. Thorax. 1979;34(1):106-12.
Dambal A, Patil BS, Hegde AC. A dissertation submitted to Karnataka University 1998.
Thiruvengadam D, Angali V, Madangopalan. Etiological diagnosis of punch biopsy of pleura. Disease of Chest. 1962;42(5):529-33.
Valdes L, Alvarez D, Valle JM, Pose A, Jose ES. The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest. 1996;109(1):158-62.
Ram KN, Jaya Sing RS. Diagnostic value of cholesterol in pleural effusions. JAPI. 1995;43(11):748-50.
Tscheikuna J, Silairatana S, Sangkeaw S, Nana A. Outcome of medical thoracoscopy. J Med Assoc Thai. 2009;92(Suppl 2):S19-23.
Kendall SW, Bryan AJ, Large SR, Wells FC. Pleural effusions: is thoracoscopy a reliable investigation? A retrospective review. Respir Med. 1992;86(5):437-40.
Mootha VK, Agarwal R, Singh N, Agarwal AN, Gupta D, Jindal SK. Medical thoracoscopy for undiagnosed pleural effusions: experience from a tertiary care hospital in North India. Medical thoracoscopy for pleural effusion. 2011;53:21-4.