European Journal of Molecular & Clinical Medicine

Introduction: Pleural effusion is common in medical ICU (MICU) patientsand may
affect patient outcomes.
Objective:This study aimed to determine the prevalence, causes, and clinical
significance of pleural effusion in critically ill patients.
Methods: A total of 500 patients included in the present study. The patients initially
had pleural effusion or effusion developed during their ICU stay.
Results: Overall, 350 patients were males and 150 were females, and their mean age was
51.5±18.6 years. Pleural effusion was found to be exudates in 60% of cases and
transudates in 40%. Uncomplicated parapneumonic effusion was the most common
cause (18%), followed by heart failure (16%). The cause of pleural effusion did not
significantly affect the patient outcome or duration of ICU stay. No significant
reduction in duration of ICU stays or ICU mortality was seen in patients who received
therapeutic aspiration or tube drainage compared with patients who received no
specific management for effusion.
Conclusion: The commonest cause of pleural effusion in MICU is parapneumonic
effusion, and chest ultrasonography is the best method of fluid detection. Different
methods of management do not significantly affect patient outcomes.

Present Study is done with an aim to co-relate the cytomorphology with Absolute LDH
gradient and Fluid ADAlevels in determining the type of pleural effusion.
On calculating the mean Absolute LDH gradient (serum-fluid LDH after dropping the
negative sign)along with standard deviation after performing the biochemical analysis of
pleural fluid, the exudative effusion fluid had an absolute LDH gradient value of
3356.20+4985.20 U/L (highest), tubercular effusion fluid had an absolute LDH gradient
value of 1361.36+ 1609.50 U/L, malignant/ suspicious of malignancy effusion fluid had an
absolute LDH gradient value of 1376+1181.79 U/L while transudative fluid had an
absoluteLDH gradient value of 107.91+61.60U/L (lowest).
On calculating the mean ADA levels along with standard deviation after performing the
biochemical analysis, the exudative effusion fluid (including tubercular) had an ADA
value of 54.37+56.71U/L (highest), malignant/ suspicious of malignancy effusion fluid had
an ADA value of 31.09+02.81U/L while transudative effusion fluid had an ADA value of
23.46+15.22U/L (lowest).
The mean and standard deviation values of ADA according to cytology reports showed that
it was highest in chronic inflammatory smear (exudates- tubercular) and least in case of
inflammatory smears (transudate).
The mean and standard deviation values of Absolute LDH gradient according to cytology
reports showed that it was highest in acute inflammatory smears (exudates) and found to
be least in case of inflammatory smears (transudate).
Using the Biserial correlation method, when the cytologic types of pleural fluid were
correlated with absolute LDH gradient values the p- value (0.011) was found to be
statistically significant in acute inflammatory smears (exudates). Alternatively, when the
cytologic types of pleural fluid were correlated with pleural fluid ADA values the p- value
(0.001) was found to be statistically significant in chronic inflammatory smears
(tubercular-exudates).
Cytomorphological analysis of body fluids is an important investigation which is very
convenient, cost effective, accurate and also safe . It gives a clue to diagnose any
underlying neoplastic or non- neoplastic diseases that may change prognosis, further
management or outcome of patient. In cases of malignant effusion it is crucial in staging
and deciding further protocol of treatment.

Background: The present study was conducted to determine 120 cases of pleural effusion underwent medical thoracoscopy.
Materials & Methods: 120 patients who underwent medical thoracoscopy in 79 Males and 41 females were recruited. Diagnostic pleural aspiration was done and the pleural fluid was analyzed for sugar, protein, Lactate dehydrogenase (LDH), Adenosine deaminase (ADA), gram-stain, Acid-fast bacilli (AFB) smear, culture, CBNAAT, and cytological analysis. Patients with unhelpful results of pleural fluid analysis (Light’s criteria) underwent medical thoracoscopy and pleural biopsy.
Results: 98 (81.7%) had pleural effusion on (CE-CT) thorax as 6 (5%) had mass lesion on left side where 6 (5%) had lesion on right side, 10 (8.3%) had other findings like passive collapse, consolidation, atelectasis, mediastinal lymphadenopathy. 13 (10.8%) patients had edematous mucosa on FOB, 19 (15.85%) patients had external compression on FOB, whereas 77 (64.2%) had the normal study on bronchoscopy, whereas 11 (9.2%) had other findings like anthracotic patches. 38 (31.7%) had inflammation, sago grain like nodules, adhesions on thoracoscopy, 25 (20.8%) had inflammation and adhesions, 51 (42.5%) had inflammation with nodules/masses/plaques, 2 (1.7%) had necrotic/ulcerative/other lesions on thoracoscopy. Conclusion: Medical diagnostic thoracoscopy should be considered in all patients having undiagnosed pleural effusion and fit for medical thoracoscopy

It is not common to diagnose a medical condition as another condition based on clinical features and investigations which later turns out to be normal because of a congenital lesion. There are many lesions reported mimicking Diaphragmatic Hernia which were treated or found during when operated for the other diagnosis. Here we report a case of Pleural effusion on the left side which was treated as Tuberculosis pleural effusion later which was found to be a congenital Diaphragmatic hernia in a middle age male.