Abstract
The aim of this study was to find out the common etiological causes of exudative pleural effusion in patients before starting treatment. Fifty patients, diagnosed with pleural effusion on admission were randomly selected from Medicine and Paediatric wards of Khulna Medical College Hospital during the period from March 2016 to November 2016. Etiological diagnosis was established by sequential clinical history and findings on physical examination, laboratory tests, chest radiograph, CT scan of the chest and pleural fluid analysis. Patients who remained undiagnosed were subjected to fibro-optic bronchoscopy, thoracoscopic pleural biopsy, and histopathology. Among the patients having pleural effusion, there were tuberculosis, pneumonia, malignancy and systemic lupus erythematosus in 27 (54%), 11 (22%), 7 (14%) and 1 (2%), respectively. Despite all investigations, 4 (8%) were remained undiagnosed etiologically. Most of the pleural effusion cases were diagnosed as tuberculosis. Early and adequate treatment resulted in complete recovery of the patients.Mediscope Vol. 4, No. 1: Jan 2017, Page 30-33
Highlights
Pleural effusion is common in respiratory medicine
20 (40%) were sputum positive for acid fast bacillus (AFB) and 7 (14%) were diagnosed by gene expert for tuberculosis
The malignant pleural effusion cases, 7 (14%), were confirmed by fine needle aspiration cytology (FNAC) of lymphnode, lung biopsy, fiber-optic broncoscopy for bronco-alveolar lavage examination and bronchial tissue biopsy for histopathological examination revealing 5 cases as adenocarcinoma of lung and 2 cases as squamous cell carcinoma
Summary
Pleural effusion is common in respiratory medicine. It is a serious local or systemic disease and calls for urgent investigations to determine its cause. Common examples are congestive cardiac failure (CCF), renal failure, superiorvenacava obstruction, constrictive pericarditis, liver cirrhosis, fluid overload, and hypoalbuminaemia, Meigs’ syndrome, etc.[3] On the other hand, inflammatory fluid leaking between cells due to local factors is termed an exudate, as in bacterial pneumonia, viral infections, tuberculosis, malignancy, subphrenic pathology and Dressler’s syndrome.[1,2,3,4] It may be noted that a malignant disease and pulmonary embolism may produce either a transudative or an exudative effusion. Exudates and transudates are best differentiated by Light’s three criteria: i) ratio of pleural fluid protein to serum protein >0.5, ii) ratio of pleural fluid to the serum lactate dehydrogenase (LDH) >0.6 and iii)
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