Details
Category: Volume 08 Issue 03 March 2020
Hits: 942

Title: Comparison of Clinical Profile of Pleural Effusion with Special References to Various Biochemical Parameters in Patients Admitted to Government Tertiary Care Center

Authors: Dr S.V.Birajdar, Dr Dinesh Mohan Chaudhari, Dr S.S.Chavan, Dr Vishal Lede

 DOI: https://dx.doi.org/10.18535/jmscr/v8i3.91

Abstract

   

Introduction

A pleural effusion is collection of fluid abnormally present in the pleural space, usually resulting from excess fluid production and/or decreased lymphatic absorption presenting with cardiopulmonary symptoms. A systemic approach to the investigations is needed because of the extensive differential diagnosis

A pleural effusion is collection of fluid abnormally present in the pleural space, usually resulting from excess fluid production and/or decreased lymphatic absorption.1 It is the most common manifestation of pleural disease, and its etiologies range in spectrum from cardiopulmonary disorders and/or systemic inflammatory conditions to malignancy. It is one of the major causes of pulmonary morbidity and mortality

Mechanisms by which the rate of fluid formation exceeds the rate of fluid absorption include increased pulmonary capillary pressure or permeability of the endothelial barrier, decreased intra pleural pressure or plasma oncotic pressure, obstructed lymphatic flow, diaphragmatic defects, and thoracic duct rupture.2 Pleural fluid aspiration followed by application of the time-honored Light’s criteria remains a remarkably useful step in the diagnostic algorithm of pleural effusions, although an expanding panel of diagnostic tools in the past decade has slowly transformed our approach to pleural diseases, the increasing complexity of which has motivated the development of multidisciplinary pleural subspecialty programs at many institutions in recent years.3, 4

Worldwide, exudative effusions are usually due to empyema, malignancy, tuberculosis, pulmonary embolism, and connective tissue diseases.5

In our setup, the common causes of exudative pleural effusions are tuberculosis, parapneumonic effusion, and malignancy. In developing nations, infections– especially tuberculosis and parapneumonic effusions, are more prevalent.6

References

  1. Diaz-Guzman E, Dweik RA. Diagnosis and management of pleural effusions: a practical approach. Compr Ther. 2007 Winter. 33(4):237-46.
  2. Akulian J, Feller-Kopman D. The past, current and future of diagnosis and management of pleural disease. J Thorac Dis 2015;7:S329-38.
  3. Bhatnagar R, Maskell N: Developing a 'pleural team' to run a reactive pleural service. Clin Med (Lond). 2013;13(5): 452–6.
  4. Diaz-Guzman E, Dweik RA. Diagnosis and management of pleural effusions: A practical approach. Compr Ther 2007;33: 237-46.
  5. Sahn SA. The differential diagnosis of pleural effusions. West J Med 1982;137: 99-108
  6. Evidence-based clinical practice guidelines. Chest. 2013 May. 143 (5 Suppl): e455S-97S.
  7. Burgess, LJ, Maritz, FJ, Le Roux, I. Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio: increased specifi city for the diagnosis of tuberculous pleuritis. Chest. 1996;109,414-9.
  8. Parikh P, Odhwani J, Ganagajalia C. Study of 100 cases of pleural effusion with reference to diagnostic approach. Int J Adv Med 2016;3:328-331.
  9. Maldhure BR, Bedarkar SP, Kulkarnl HR, Paplnwar SP. Pleural biopsy and adenosine deaminase in pleural fluid for the diagnosis of tubercular pleural effusion. Ind J Tub. 1994;41:161–5
  10. Hirsch A, Ruffie P, Nebut M. Pleural effusion: laboratory tests in 300 cases. Thorax. 1979;34(1):106-12.
  11. Ghosh B. K, Bandyopadhyay U. A Study of Etiology and Clinical Profile of Patient with Pleural Effusion in a Teaching Hospital.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 18, no. 9, 2019, pp 19-23.
  12. Marel M, Arustova M, Stasny B et al. Incidence of pleural effusion in a well-defined region: epidemiologic study in central Bohemia. Chest 1993;104:1486-1489.
  13. Laim CK, Wong CM. Causes of pleural exudates in a region with a high incidence of tuberculosis. Respirology. 2000;5:33-38.
  14. Liang QL, Shi HZ, Wang K et al. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: A meta-analysis. Respir Med, 2008;102:744-754.
  15. Diaacon AH, Van de wal BW, Wyser C, Smedema JP, Bezuidentront J, Bolliger CT, Walzi G: Diagnostic tools in tuberculous pleurisy : a direct comparative study. Eur Respir J 2003;22: 589-591.
  16. Godwin C M, Ajuonuma B. C, Ofondu E. O, Aguwa E.l N. Pleural effusion: Aetiology, clinical presentation and mortality outcome in a tertiary health institution in Eastern Nigeria – A five year retrospective study. J AIDS Clin Res 2015;6:2.
  17. Kaushal MB, Krupal PM. Pleural effusion: A two years prospective study in western India. Sch J App Med Sci. 2015;3(8A): 2790-793.

Corresponding Author

Dr Dinesh Mohan Chaudhari

Resident, Department of General Medicine, S.R.T.R.GMCH Ambajogai (Maharashtra)