ABSTRACT
Background and Objective: Malignant pleural effusion (MPE) is a known complication of both thoracic and extrathoracicmalignancies. A detailed clinical and investigative profile of patients presenting with MPE would allow us to intervene early inthe disease and would ensure a better prognosis.Materials and Methods: A prospective study of 60 cases of MPE was carried out in the Department of Thoracic Medicine andCardiothoracic surgery, Thanjavur Medical College Hospital, Thanjavur, from October 2017 to May 2018, with respect to age,sex, clinical findings, biochemical analysis, radiological, cytological investigations, and histopathology.Results: The most common age group of MPE is between 60 and 70 years, male-to-female ratio was 1:1. The right-sidedpleural effusion was a more common finding compared to the left-sided effusion; pleural fluid biochemical analysis revealed amean adenosine deaminase of 23.97 u/l, mean pleural fluid protein/serum protein ratio was 0.95, and mean pleural fluid glucosewas 38.75 mg/dl. Of 60 cases, the most common cause of MPE was adenocarcinoma of lung which accounted for 30 cases,followed by metastatic carcinoma 24 cases and squamous cell carcinoma lung 3 cases and pleural mesothelioma in 3 cases.Conclusion: Pleural fluid cytology analysis for malignant cells was sufficient to diagnose MPE in 85% of cases, and in remainingcases, pleural biopsy can be helpful. The most common primary in cases of MPE was adenocarcinoma of lung.
ABSTRACT
Background: Pleural effusion is one of the most common signs seen in respiratory pathologies. An attempt to establish commonetiologies underlying pleural effusion helps in effective management of the same.Materials and Methods: After obtaining proper informed consent, patients presenting with pleural effusion underwent clinicalexamination in addition to radiological and biochemical investigations. Where needed, the diagnosis was confirmed usingpleural biopsy and bacteriological analysis.Results: Investigations confirmed tuberculosis in 23 patients, malignancy in seven cases, congestive cardiac failure in fourcases, parapneumonic causes in 12 patients, hypoproteinemia in two patients, and pulmonary thromboembolism in two patients.Conclusion: The present findings show that tuberculosis is the most common cause of pleural effusion in our patients. A morecomprehensive study would help us to further strengthen our findings.
ABSTRACT
Background: Medical thoracoscopy is a minimally invasive, safe, and cost-effective procedure that allows complete visualizationof pleural space, enabling diagnostic and therapeutic procedures such as pleural biopsy and talc insufflations. Conservativeestimates suggest that 25% of patients seen in general pulmonologist’s practice involve pleura, of these 25% are unable to beattributed to a specific diagnosis, even after thoracentesis and closed pleural biopsy.Aim: The aim of this study was to evaluate the diagnostic yield of rigid thoracoscopy in undiagnosed pleural effusion.Methods: This prospective observational descriptive study was conducted in Thanjavur Medical College Hospital, Tamil Nadu,in the Department of Thoracic Medicine between July 2017 and December 2018. Rigid thoracoscopy equipment was used forinvestigation. 12 undiagnosed pleural effusion patients after thoracentesis who fulfilled inclusion and exclusion criteria wereincluded in the study.Results: Of the 12 patients, six were male and six were female; seven had right-sided pleural effusion and five had left sidedpleural effusion. Investigation reports were inconclusive except for suggesting an exudative effusion. Cytological examinationsof pleural fluid were inconclusive in all the patients. After thoracoscopy, tuberculosis was diagnosed in five cases, metastasesin three cases, mesothelioma in two cases, and inflammatory pathology in two cases.Conclusion: Thoracoscopy is a safe procedure with high diagnostic yield in undiagnosed exudative pleural effusion (EPE).Asimple, minimally invasive low-cost investigation reduces the need for more invasive and much more expensive thoracotomy.Our study proved that rigid thoracoscopy remains the investigation of choice in all undiagnosed EPE for accurate diagnosisand management.
ABSTRACT
Background: The incidence of malignant pleural mesothelioma (MPM) has increased for some decades and was expected topeak between 2010 and 2020. The prevalence of MPM in India is unclear. No such study is available regarding MPM in India.Materials and Methods: After obtaining proper informed consent, patients presenting with pleural effusion were subject topleural biopsy, and the samples were then sent to histopathological confirmation of malignancy.Results: Histopathological evidence confirmed two cases of MPM of the 12 cases. Five of them were diagnosed with tuberculosispleuritis, while two cases had inflammatory pathology and two cases were confirmed to have been metastatic tumors.Conclusions: The present findings show that the prevalence of MPM is rather high at about 16%. A more comprehensivestudy is warranted based on our findings.