Evaluation of Coelomic Fluids and its Clinical Correlation with Cytologic Diagnosis

Abstract

Background: Aspiration of coelomic fluids from coelomic cavities is a simple and relatively, non-invasive technique to achieve a diagnosis. Pleural effusion, pericardial effusion and peritoneal effusion are commonly encountered problem by general physicians and chest physician. Effusion often present as a common diagnostic dilemma as no cause can be found in many cases inspite of careful evaluation. A better knowledge of spectrum of clinical history and clinical signs of pleural effusion, pericardial effusion and peritoneal effusion along with radiological, biochemical and cytological evaluation of the fluids helps in narrowing the diagnostic dilemma faced by physicians and helps in better management of patients. Objective: This study was undertaken to evaluate the coelomic fluids and its clinical correlation with cytologic diagnosis. Method: This was a prospective study conducted on 70 patients of pleural, pericardial and peritoneal effusions, satisfying inclusion criteria during the period between January 2012 to May 2013, presenting to the department of pathology, College of medical Sciences-Teaching hospital, Bharatpur. A detailed clinical history of the patient was obtained from the clinical protocol of hospital records in the proforma. Fluid from the pleural, pericardial and peritoneal cavity was obtained by thoracocentesis, pericardiocentesis and paracentesis performed by clinicians and analyzed for cytological diagnosis. Then, the cytological findings and clinical diagnosis were correlated. Statistical analysis was done using SPSS (Statistical Package for Social Sciences). The body fluids submitted from different department of COMS-TH were evaluated by cytological study and its clinical correlation was done. The prime objective of this study was to convey a diagnosis which would guide a clinician to correct diagnosis, hence the therapy. Results: The present study includes 70 cases of pleural fluid, pericardial fluid and peritoneal fluid and analysis was done. Out of 70 cases, 34 cases are of peritoneal fluid, 31 cases are of pleural fluid and five cases are of pericardial fluid. Age of the patients ranged from eight years to ninety years with males to female ratio of 1.6:1 with a mean age of 50.36 years. The most common presenting complain were abdominal distension, swelling of lower limbs and yellowish discoloration of sclera (42.9%) followed by cough, fever, chest pain, shortness of breath, loss of appetite and loss of weight (30%) followed by abdominal distension, swelling of lower limbs, yellowish discoloration of sclera, loss of appetite and loss of weight (12.9%) followed by chest pain, shortness of breath, loss of appetite and loss of weight (7.1%) followed by cough, fever, and chest pain (5.7%) followed by loss of appetite and loss of weight (1.4%). Out of 70 cases, 59 cases diagnosed as chronic effusion (84.28%). Six cases are diagnosed as inflammatory effusion (8.57%) and five cases are of malignant effusion (7.14%) on cytological evaluation. Out of five cases of malignant effusion two cases are of malignant mesothelioma. Of the total 70 cases of effusion, 50% were turbid, 47% were clear and 2.9% were hemorrhagic in appearance. 52.9% of effusions were exudative and 47.1% of effusion were transuadative. The mean fluid glucose level on transudative effusion were in the range of 80.15 ± 21.19 mg/dl which was higher as compared to exudative effusion and this difference was statistically highly significant (p value = 0.010). The mean fluid total protein levels in transudative effusion were in the range of 2.08 ± 0.43 gm/dl which can be classified as transudative form as compared to exudative form and this is highly statistically significant (p value = 0.001). The total leukocyte count ranged from 57 to 1,50,000 cells/mm3. The estimated mean ± SD of pleural, peritoneal, pericardial fluid cell count of all 70 cases were 3151.5 ± 17974.06. This was statically not significant (p value = 0.141). The average cell count in malignant effusion, chronic effusion and inflammatory effusion was 620 cells/mm3, 520 cells/mm3 and 31,141 cells/mm3 respectively.