Title: Etiological, Radiological, Biochemical and Cytological Analysis of Pleural Effusion
Authors: Dr B.Satvik, Dr K. Spandana, Dr K. Aiswarya, Dr K. Rajani Devi
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.162
Abstract
Background: Pleural effusion is the excessive or abnormal accumulation of fluid in the pleural space. Pleural effusion is routinely facing problem in practice by general physician and chest physician. For better management of cases to obtain knowledge of clinical history and clinical signs of pleural effusion along with radiological, biochemical and cytological evaluation of pleural fluid help in narrowing the diagnosis.
Methods: In this, prospective study of 60 patients with pleural effusion with respect to age, Sex, presenting complaint, clinical history with radiological biochemical and cytological examination of pleural fluid are considered.
Results: In this prospective study of 60 patients with pleural effusion, them can age 11 to 75 years and two third were men. The most common type of pleural effusion is exudative effusion. The most common cause of exudative effusion in this study were tuberculosis (36), followed by malignancy (9), Transudative (8), Syn-pneumonic (5) and 2 cases of empyema (2). Pleural effusion were commonly seen in male patient with maximum number of cases in age group – 31-50. Pleuritic chest pain, fever, cough and breathlessness were common presenting complaint. The commonest clinical sign was stony dullness to percussion. Right side effusions were more common. Majority had moderate amount of pleural effusions. Blood count and ESR were significantly elevated in exudatives. Pleural fluid cytology revealed elevated Lymphocytes in tubercular and polymorphs in acute infections. Cytology for malignant cells were diagnostic in 4 cases.ADA was significantly elevated in tubercular pleural effusion. Exudatives had decreased glucose but increased protein, LDH and cholesterol compared to transudatives.
Conclusion: Tubercular effusion remains the commonest etiology of all exudative effusions in our study. It involves the young and is associated with fever and cough as the most common presenting symptom. Malignant effusion were seen in older age group with cough and dysponea as common symptoms. Massive effusion with haemorrhagic pleural fluid is commonly associated with malignant effusion
Keywords: Exudative, transudative, tubercular malignant, synpneumonic, empyema, pleural effusion.
References
- Light R W. Anatomy of pleura pleural disease. Pleural diseases. 4th ed. Philadelphia: Lippincott Williams and Wilkins, 2001 Richard W. Light.
- Pleural effusion N Engl J Med 2002; 346: 1971-1977.
- Maldhure, Bedharkar Kulkarni et al. Pleural biopsy and adenosine deaminase in the pleural fluid in the diagnosis of tubercular pleural effusion. Ind J Tuberculosis 1994; 41: 161-164.
- Text book of preventive and social medicine. Epidemiology of Tuberculosis. 18th edition 2005, Bansarilal publications Park. Text book of preventive and social medicine. Epidemiology of Tuberculosis. 18th edition 2005, Bansarilal publications.
- Light RW, Establishing the diagnosis of tuberculous Arch Intern Med 1998; 158: 1967-1968.
- Alfagem I, Munoz F, Pena N et al. Empyema of the thorax in adults Etiology, microbiology and management. Chest 1993; 103: 1502-1507.
- Clinical implications of appearance of pleural fluid at thoracocentesis,Jan 125(1):156-9
- S national library of medicine national institutes of health Light RW Parapneumonic effusions Pleural diseases 4th edition, Lippincott Williams and Wilkins 2001
- Valdes L, Alvarez D, San Jose E et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 1998; 158: 2017-2021.
- Cheng D-S,KZ mannum Rodriguez RM, Rogers J, et Comparison of pleural fluid pH values obtained using blood gas machine, pH meter, and pH indicator strip. Chest 1998; 114: 1368-1372.
- Journal of post graduate medicine, 1993,volume 39,issue 4,page 190-3.
- International journal of advances in medicine 2015;2(4):359-364
- 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- 1364.
- Us national library of medicine national institutes of health,1991 may;4(3):320-4.
- Diagnostic efficacy of pleural biopsy as compared with that of pleural fluid examination.
- Light R W. Management of parapneumonic effusions. Arch Intern Med 1981;141: 1339-1341
- Amit B, Khilani GC, Sharma SK et al. A study of empyema thoracis and the role of intrapleural streptokinase in its management. BMC infectious diseases 2004;4: 19-23.