Vijay Naik
BACKGROUND
Pleural effusion is very common worldwide, which is broadly differentiated into exudative and transudative types depending upon various characteristics of fluid. This broad division further classified depending upon aetiology. Main cause of pleural effusion in developing countries including India is tuberculosis. Effusion due to malignancy is also common in India especially among elderly age group individuals. Diagnostic methods include pleural fluid analysis, thoracoscopic studies and pleural biopsy. Histopathological examination of the pleura is very much important in deriving the definitive diagnosis of the pleural effusion.
MATERIALS AND METHODS
50 random cases were selected and made to undergo pleral biopsy with Abrams punch biopsy needle after ruling out bleeding diathesis. Citrated pleural fluid was collected for cytological and biochemical analysisas well. Simultaneously, sample of pleura was sent for histopathological analysis. Based on the presence or nature of mesothelial lining ,a reporting of normal pleura, inadequate for reorting,tuberculous or malignant was done.Sample was also sent for bacteriological studies. Four out of five transudates on biopsy showed normal pleura giving a specificity of 80%.
RESULTS
The age group ranged from 14 to 80 years. Male-to-female ratio was 3:1. Effusions were more frequent on right side as compared to left. Radiologically, all had pleural effusions and sputum for AFB was negative in all cases. Majority of the straw-coloured effusions were tubercular effusions, whereas most of malignant effusions were haemorrhagic. Two-third of these cases showed tubercular granuloma and a small number were found to have malignancy. A significant number (41%) showed nonspecific pleuritis.
CONCLUSION
A definitive diagnosis of tuberculosis or malignancy could be established in 16 (32%) cases by pleural biopsy alone, thus showing a sensitivity of 38%, which enhanced to 40% on combining histopathological and pleural fluid cytological examination.
