A study of pleural effusion with reference to different diagnostic modalaties
Keywords:Pleural effusion (PE), Adenosine deaminase (ADA), Malignancy
Background: Aim of current study was to determine the different etiologies of pleural effusion and efficacy of diagnostic methods.
Methods: 100 patients of pleural effusion of both sexes were taken randomly coming to our institution either indoor or OPD. Inclusion criteria: 100 patients of pleural effusion of any age and of either sex in whom thoracentesis can yield minimum amount of pleural fluid for diagnostic purposes. Exclusion criteria: Patients of pleural effusion in whom fluid could not be aspirated were excluded from the study.
Results: In this study 70% of the patients were male and 30% were female. Most of the patients were between 21-30 years of age. 92% of the pleural effusion was exudative and 8% was transudative. Tuberculosis is the most common (44%) cause of pleural effusion followed by malignancy (23%), 5% of the patients remains undiagnosed. Sensitivity, specificity, NPV, PPV of Light’s criteria is 100% to differentiate between transudates and exudates. Among parameters of Light's criteria pleural LDH has highest specificity (100) and sensitivity (100) and NPV (80%). Sensitivity, specificity, NPV, PPV of ADA to differentiate between tuberculous and non tuberculous pleural effusion is 100%, 95%, 100%, 96.77% respectively. Pleural biopsy was positive in 80% of the tuberculous patients while in malignancy it was positive only in 20% of the patients.
Conclusions: Tuberculosis remains to be main cause of pleural effusion in India. Light’s criteria is most specific & sensitive to diagnose between exudative & transudative pleural fluid. ADA is highly sensitive & specific to differentiate between tuberculous & nontuberculous pleural effusion. In centres where thorascopy is not available for undiagnostic cases of pleural effusion, pleural biopsy can be helpful in fair no. of cases for diagnosis.
Edmund Leuallen, Carr David. Pleural effusion: a study of 436 patients. N Engl J Med. 1955;252(3):156-60.
Light RW, Glickmen RM, Isselbreher K. Disorders of pleura, mediastinum and diaphragm. In: Light RW, Glickmen RM, Isselbreher K, eds. Harrison’s Principle of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998: 1473-1476.
Sharma SK, Suresh V, Mohan A, Kaur P. A prospective study of sensitivity and specificity of adenosine deaminase estimation in the diagnosis of tuberculosis pleural effusion. Indian J Chest Dis Allied Sci. 2001;43(3):155.
Maldhure BR, Bedarkar SP, Kulkami HR, Papinwar SP. Pleural biopsy and adenosine deaminase in pleural fluid for the diagnosis of tuberculous pleural effusion. Indian J Tuberc. 1994;41:161-5.
Burgess Lesley, Matiz Frans, Taljaard Frans. Comparative analysis of the biochemical parameter used to distinguish between pleural transudates and exudates. Chest. 1995;107(6):1604-9.
Hinrich, Hamm, Brohan Vwe. Cholesterol in pleural effusion: a diagnostic aid. Chest. 1987;92(2):296-302.
Storey DD, Dines DE, Coles DT. Pleural effusion: a diagnostic dilemma. JAMA. 1976;236:2183-6.
Hirsch A, Ruffie P, Nebut M. Pleural effusion: laboratory tests in 300 cases. Thorax. 1979;34:106-12.
Light Richard, Isabele Margregar. Pleural effusion: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77:507-13.
L. Valdes, E. San Jose, D. Alvarez, J. M. Valle. ADA isoenzyme analysis in pleural effusions: diagnostic roll, and relevance to the origin of increased ADA in tuberculous. Pleursy Eur Respir J. 1996;9:747-51.
Subhakar K, Kotilengani K, Satyasri S. Adenosine deaminase activity in pleural effusion. Lung India. 1991;IX(2):57-60.
Piras MA, Gakis C, Budroni M, Andreoni G. Adenosine deaminase activity in pleural effusion: an aid to differential diagnosis. Br Med J. 1978;2:175.
Thiruvengadam D, Angali V, Madangopalan. Etiological diagnosis of punch biopsy of pleura. Dis Chest. 1962;42:529.
Valdes Luis, De Alvarez, Pose Antonio, Sudrez Javer. Cholesterol a useful parameter for distinguishing between pleural exudates & transudates. Chest. 1991;99(5):1097-102.
Heffner JE, Sahn SA, Brown LK. Multilevel likelihood ratio for identifying exudative pleural effusion. Chest. 2002;121:1916-20.
Heffner JE, Highland K, Brown LK. A meta-analysis derivation of continuous likelihood ratio for diagnosing pleural fluid exudates. Am J Respir Crit Care Med. 2003;67:1591-9.
Irani R, Underwood Reba, Greenberg Donald. Malignant pleural effusion. Arch Int Med. 1987;147:1133-6.
Menon KN. Steroid therapy in tuberculous pleural effusion. Tubercle London. 1964;45:17-20.
Santiago Romero, L. Hernandez, D. Orts, C. Fernandez. Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest. 2002;122:1524-9.
Luis Valdes, De Alvarez, E San Jose. Tuberculous pleurisy: a study of 245 patients. Arch Intern Med. 1998;158:2017-21.
Heffher JE. Evaluating diagnostic tests in the pleural space. Clin Chest Med. 1998;9(2):277-93.
Gilhotra R, Seagal S, Jindal SK. Pleural biopsy & ADA enzyme activity in effusions of different etiologies. Lung India. 1989;7(3):122-4.
Lloyd MS. Thoracoscopy & biopsy in the diagnosis of pleurisy with effusion. Q Bull Sea View Hosp. 1953;14:128-33.
Sinha PK. Comparative sensitivity of mycobacterial culture, histopathology & adenosine deaminase activity. JAPI. 1985;33(10):644-5.
Salyer WR. Efficacy of pleural needle biopsy & pleural fluid pathology in the diagnosis of malignant neoplasm involving the pleura. Chest. 1975;67:536.