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Article type :

Original Article

Author :

M Brighton, J K Mishra, G N Srivastava, Amrita Ghosh Kar, Anbarasan T, Akhilesh Tiwari, Sujeet Kr Karn, Saurabh Mishra, Ritamvara Oli, B Gowthami, Aiyush Jain

Volume :

8

Issue :

1

Abstract :

Introduction: Sometimes etiological diagnosis of pleural fluid is not possible even after complete biochemical and cytological examinations and labeled as undiagnosed pleural effusion. So, there is a need of simple, rapid, easily available and reliable diagnostic test to establish the etiology of pleural effusion. Our aim of this study is to make an etiological diagnosis in such undiagnosed exudative effusion with pleural biopsy. Materials and Methods: In this study, patients with undiagnosed exudative pleural effusion where the diagnosis was not made by complete analysis and cytological examination of pleural fluid were included. Pleural tissue was obtained by Abram’s Needle after obtaining proper consent and sent it for histopathological examination to find out the etiology. Result: Out of 92 patients, 68.50% (n=63) were males and 31.50%(n=29) were females. The side of pleural effusion was right-sided in 36.95% (n=34) and left-sided in 63.05% (n=58). The mean value of polymorphs and lymphocytes count was 30.35% and 64.92% respectively. Pleural fluid was hemorrhagic in 32.60% (n=30) patients, straw-colored in 58.7% (n=54) patients and clear in 8.7%(n=8) patients. The mean level of protein was 4.5gm/dl (range 3.59-5.41). Histopathology showed granulomatous inflammation compatible with tuberculosis in 62% (n=57) cases, metastatic malignancy in 38% (n=35) cases. Among 35 cases of malignancy, 51.42% (n=18) cases showed adenocarcinomas, 28.57%(n=10) cases showed squamous cell carcinoma,11.42%(n=4) cases showed lymphoma and 8.57%(n=3)cases showed solitary fibrous tumor. Conclusion: Our study suggests that tuberculosis and malignancy are the two common etiologies for exudative pleural effusion. Closed pleural biopsy using Abram’s needle is easily available, inexpensive and has good yield accuracy of diagnosis in cases with uncertain etiology by pleural fluid analysis and has low complication rate.