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Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer
Antonangelo, Leila; Vargas, Francisco Suso; Seiscento, Marcia; Bombarda, Sidney; Teixera, Lisete; Sales, Roberta Karla Barbosa de.
  • Antonangelo, Leila; University of São Paulo. Medical School. Hospital das Clínicas. Division of the Central Laboratory. São Paulo. BR
  • Vargas, Francisco Suso; University of São Paulo. Medical School. Hospital das Clínicas. Heart Institute-Incor. São Paulo. BR
  • Seiscento, Marcia; University of São Paulo. Medical School. Hospital das Clínicas. Heart Institute-Incor. São Paulo. BR
  • Bombarda, Sidney; University of São Paulo. Medical School. Hospital das Clínicas. Heart Institute-Incor. São Paulo. BR
  • Teixera, Lisete; University of São Paulo. Medical School. Hospital das Clínicas. Heart Institute-Incor. São Paulo. BR
  • Sales, Roberta Karla Barbosa de; University of São Paulo. Medical School. Hospital das Clínicas. Heart Institute-Incor. São Paulo. BR
Clinics ; 62(5): 585-590, 2007. tab
Article in English | LILACS | ID: lil-465115
ABSTRACT

PURPOSE:

To evaluate the clinical and laboratory characteristics of pleural effusions secondary to tuberculosis (TB) or cancer (CA).

METHODS:

A total of 326 patients with pleural effusion due to TB (n=182) or CA (n=144) were studied. The following parameters were analyzed patient gender, age and pleural effusion characteristics (size, location, macroscopic fluid aspect, protein concentration, lactate dehydrogenase (DHL) and adenosine deaminase activity (ADA) and nucleated cell counts).

RESULTS:

Young male patients predominated in the tuberculosis group. The effusions were generally moderate in size and unilateral in both groups. Yellow-citrine fluid with higher protein (p < 0.001) levels predominated in effusions from the tuberculosis group (5.3 + 0.8 g/dL) when compared to the CA group (4.2 ± 1.0 g/dL), whereas DHL levels were more elevated in CA (1,177 ± 675 x 1,030 ± 788 IU; p = 0.003) than in TB. As expected, ADA activity was higher in the TB group (107.6 ± 44.2 x 30.6 ± 57.5 U/L; p < 0.001). Both types of effusions presented with high nucleated cell counts, which were more pronounced in the malignant group (p < 0.001). TB effusion was characterized by a larger percentage of leukocytes and lymphocytes (p < 0.001) and a smaller number of mesothelial cells (p = 0.005). Lymphocytes and macrophages were the predominant nucleated cell in neoplastic effusions.

CONCLUSION:

Our results demonstrate that in lymphocytic pleural exudate obtained from patients with clinical and radiological evidence of tuberculosis, protein and ADA were the parameters that better characterize these effusions. In the same way, when the clinical suspicion is malignancy, serous-hemorrhagic lymphocytic fluid should be submitted to oncotic cytology once this easy and inexpensive exam reaches a high diagnostic performance (approximately 80 percent). In this context, we suggest thoracocentesis with fluid biochemical...
RESUMO

OBJETIVO:

Avaliar as características clínicas e laboratoriais de derrames pleurais secundários à tuberculose ou câncer.

MÉTODOS:

Um total de 326 pacientes com derrame pleural por tuberculose (n=182) ou câncer (n=144) foi avaliado. Os seguintes parâmetros foram analisados sexo e idade dos pacientes e características do líquido pleural (tamanho, localização, aspecto macroscópico, concentração de proteínas, atividade da desidrogenase lática (DHL) e da adenosina deaminase (ADA) e contagem de células nucleadas).

RESULTADOS:

A tuberculose pleural predominou nos pacientes mais jovens e do sexo masculino. Em ambos os grupos, os derrames pleurais foram de tamanho moderado e unilaterais. Derrames com aspecto amarelo-citrino com níveis mais elevados de proteínas predominaram na tuberculose (5,3 ± 0,8 g/dL), quando comparados aos neoplásicos (4,2 ± 1,0 g/dL), enquanto que níveis mais elevados de DHL foram observados nos derrames neoplásicos (1.177 ± 675 x 1.030 ± 788 UI; p = 0,003). Conforme esperado, a atividade da ADA foi maior na tuberculose que no câncer (107,6 ± 44,2 x 30,6 ± 57,5 U/L; p < 0,001). Ambos os derrames apresentaram alta celularidade, embora mais pronunciada no grupo neoplásico (p < 0,001). Os derrames de etiologia tuberculosa se caracterizaram por apresentar uma maior percentagem de leucócitos e de linfócitos (p < 0,001) e um pequeno número de células mesoteliais (p = 0,005). Linfócitos e macrófagos foram as células nucleadas que predominaram nos derrames pleurais malignos.

CONCLUSÃO:

Nossos resultados demonstram que em exsudatos pleurais linfocíticos de pacientes com evidências clínicas e radiológicas de tuberculose, os níveis de proteína e de ADA foram os parâmetros que melhor caracterizaram esses derrames. Da mesma maneira, quando a suspeita clínica é câncer, um líquido serohemorrágico e linfocítico deve ser submetido à citologia oncótica, uma vez que este exame laboratorial de fácil...
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Pleural Effusion / Tuberculosis, Pulmonary / Adenosine Deaminase / L-Lactate Dehydrogenase / Lung Neoplasms Type of study: Diagnostic study Limits: Adult / Female / Humans / Male Language: English Journal: Clinics Journal subject: Medicine Year: 2007 Type: Article Affiliation country: Brazil Institution/Affiliation country: University of São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Pleural Effusion / Tuberculosis, Pulmonary / Adenosine Deaminase / L-Lactate Dehydrogenase / Lung Neoplasms Type of study: Diagnostic study Limits: Adult / Female / Humans / Male Language: English Journal: Clinics Journal subject: Medicine Year: 2007 Type: Article Affiliation country: Brazil Institution/Affiliation country: University of São Paulo/BR