Study of Etiological Diagnosis in Patients Admitted with Pleural Effusion

Abstract

Collection of an abnormal quality/quantity of fluid in the pleural cavity is called pleural effusion. There are various causes for pleural effusion. It is a common respiratory        condition known since the time of Hippocrates. Because of the various etiological factors that can cause pleural effusion, it often present as a diagnostic dilemma, even after extensive investigations. The first step is the distinction between  transudates and exudates as this gives an indication of the pathophysiology, differential diagnosis and the plan for further investigations. The diagnosis of the cause of pleural effusion is usually done by clinical, radiological, pathological and laboratory findings.  Tuberculosis is still the most common cause of exudative pleural effusion in our country. Tuberculosis  remains a major cause of morbidity and mortality in most    developing countries.Every year approximately 1.8 million people develop TB and about 0.4 million die from it.           Tuberculosis kills more adults in India than any other   infectious disease. Pleural effusion is second most common form of extrapulmonary tuberculosis next to tuberculosis     lymphadenitis. About 20 % cases of extrapulmonary  tuberculosis presents with pleural effusion.Excess accumulation of fluid in the pleural space occurs due to the following mechanisms.1) Increase in the hydrostatic pressure in the pulmonary circulation, 2) A  decrease in the oncotic pressure. 3) A decrease in pressure in the pleural space,4) Increase in the permeability of  microvascular circulation.The objectives of the study are; (1) To study the clinical profile and diagnostic approach to patients admitted with pleural effusion; (2) To study the  importance of repeated pleural fluid sampling versus single analysis in diagnosing malignant cells.(3) To study the  association between ADA levels and the diagnostic approach to exudative effusion. (4) To study efficacy of pleural biopsy in undiagnosed pleural effusion. Excess accumulation of fluid in the pleural space occurs due to the following mechanisms.1) Increase in the hydrostatic pressure in the pulmonary circulation,2) A decrease in the oncotic        pressure.3) A decrease in pressure in the pleural space, 4) Increase in the permeability of  microvascular circulation.The objectives of the study are;(1) To study the clinical profile and diagnostic approach to patients admitted with pleural effusion; (2) To study the importance of repeated pleural fluid sampling versus single analysis in diagnosing malignant cells.                   (3) To study the association between ADA levels and the diagnostic approach to exudative effusion. (4) To study efficacy of pleural biopsy in undiagnosed pleural effusion.