ETIOLOGICAL, CLINICO-RADIOLOGICAL AND MICROBIOLOGICAL PROFILE OF EXUDATIVE PLEURAL EFFUSION
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 1, Pages 1462-1469
AbstractBACKGROUND: There are various causes of exudative Pleural effusion, rather than assumption of a diagnosis by clinical suspicion, proper diagnosis is needed in guiding specific targeted treatment. Exudative pleural effusions necessitate thorough investigation and specialized diagnostic methods. The main objective of this study is to determine the aetiologies of exudative pleural effusion, and to assess clinical profile along with radiological and microbiological profiling in current scenario in Western Maharashtra.
MATERIALS AND METHODS: A prospective, observational and cross-sectional study was done on 114 patients of exudative pleural effusion in a tertiary care centre. Patients above 10 years of age with biochemical evidence of exudative effusion were only included in the study. Biochemical, cytological and microbiological tests were done on their pleural fluid and their clinical profile was noted. In selected cases, Patients underwent pleural biopsy, Video Bronchoscopy and Image guided Lung Biopsy.
RESULTS: In young population, females were more affected (57%) whereas in middle age and in elderly population, males were more affected. Dyspnoea was the most common symptom. Radiological profiling showed majority had moderate effusion and preferably right sided effusion and >50% effusion were loculated. 70.2 % were of tubercular aetiology, 14 % were of malignant effusion, 10.5 % were of Para pneumonic effusion and 5.3 % were effusion secondary to pancreatitis. Estimation of pleural fluid adenosine deaminase plays an important role in the diagnosis of tubercular effusion. Fluid cytology and closed pleural biopsy helped in diagnosis of malignant effusion.
CONCLUSION: Tuberculosis is still the commonest causes of exudative effusions in western Maharashtra after which there is Para pneumonic effusions and malignant effusion. All patients should undergo ultrasonography of thorax to see for loculated pleural effusion. Though Pleural fluid ADA levels are highly sensitive with specificity for the diagnosis, along with that Pleural biopsy, Pleural fluid cytology and Image guided lung biopsy are necessary in indicated cases to correlate with the diagnosis. In case of workup of undiagnosed exudative effusion, Bronchoscopy and CT Pulmonary Angiogram (CTPA) proved to be an important investigation in arriving to a conclusion.
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