Harish G. M1, Vivek K. U2
OBJECTIVE
Pleural effusion refers to the excessive or abnormal accumulation of fluid in the pleural space. Pleural effusion is commonly encountered medical problem and caused by a variety of underlying pathological conditions. It is important to establish an accurate etiological diagnosis, so that the patient may be treated in the most appropriate and rational manner.
METHODS
This was a prospective study of 56 pleural effusion patients who are attending OPD and admitted cases in the Pulmonary Medicine department in Bhagwan Mahaveer Jain Hospital, Bangalore. The patients were subjected to through clinical history and examination. Thoracocentesis did under aseptic conditions and pleural fluid sent for investigations like protein, sugar, LDH (Lactate Dehydrogenase), ADA (Adenosine Deaminase), gram staining, AFB smear and culture by BACTEC method, cell type, cell count, and malignant cytology. Pleural biopsy was done for those who are willing for the same. Depending upon the history and clinical examinations and laboratory investigations, patients were classified as having exudates and transudates.
RESULTS
The total of 56 patients with pleural effusion was studied. Mean age of the study group was 43±14.6 years. 39(69.42%) patients were male and 17(30.58%) patients were female. The commonest type of effusion being tuberculosis (34) followed by malignancy (8), transudative effusion (7), synpneumonic (5) and 2 cases of empyema. The commonest presenting complaints were cough (78.32%) and breathlessness (74.76%). Polymorphs were predominant in synpneumonic effusion and empyema and lymphocytes in tubercular effusion. Pleural fluid cytology revealed elevated lymphocytes in tubercular and polymorphs in acute infections. Cytology for malignant cells was positive in 4 cases. The mean increase in ADA level in tubercular pleural effusion, malignant pleural effusion and transudative pleural effusion were 79±19.9 IU/L, 42.6±9.3 and 28.4±8.2 respectively and it was statistically significant (p <0.001).
CONCLUSION
Even in the advanced diagnostic approaches, still detailed clinical history and examination of the patient is important to make a clinical diagnosis. All suspected cases of pleural effusion 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 Pulmonologist for further evaluation of the patient if required. In the differential diagnosis of pleural effusions simultaneous determination of serum-pleural fluid protein ratio, ADA and LDH are to be included along with the routine analysis of pleural fluid glucose and total protein which helps to differentiate between exudates and transudates. It also helps to differentiate between tubercular and non-tubercular effusion.
