A Analytical Study of Clinical Profile of Pleural Effusion

INTRODUCION: Pleural effusion is an abnormal accumulation of fluid in the Pleural space. The pleural space lies between the lung and chest wall and normally contains a very thin layer of fluid, which serves as a coupling system. Excess fluid results from the disruption of the equilibrium that exists across pleural membranes. Pleural effusion is an indicator of a pathologic process that may be of primary pulmonary origin or of an origin related to another organ system or occasionally the first evidence of some other systemic disease. It may occur in the setting of acute or chronic disease and is not a diagnosis in itself. Diagnosing the etiology of pleural effusions clinically with certainty is a challenging task for physicians. The advancements in the field of medicine and with the advent of various diagnostic aids like pleural fluid analysis, pleural fluid cytology, pleural biopsy, ultrasonography, bronchoscopy, biopsy of scalene lymph node, serological tests like ANA, ADA, Rheumatoid factor, Pleural fluid Amylase, CT thorax help the physician to arrive at the diagnosis at an earlier course of the disease. Here I have made an attempt to arrive at the etiological diagnosis of 100 cases of pleural effusion by collecting relevant clinical as well as laboratory data using the recent modalities available in our hospital. AIM OF THE STUDY: 1. To study about the clinical presentation of various causes of pleural effusions. 2. To identify the spectrum of pleural effusion in 100 cases of pleural effusion admitted in Govt.S.M.C.H between 2007-2008. 3. To study about the rare causes of pleural effusion in our hospital. MATERIALS AND METHODS: Study Place: Stanley Medical College & Hospital, Department of Medicine. Study Duration: Study was done over a period of 18 months, from January 2007 to June 2008. Study Population: Patients admitted with pleural effusion in the department of medicine were included in the study. Study Design: Cross-sectional study. Inclusion Criteria: 1. Any case of Pleural effusion, 2. Age 13-85 years. Exclusion Criteria: 1. Age < 13 years, 2. Hemodynamically unstable patients, 3. Pregnant women, 4. Patients with bleeding tendencies. METHODOLOGY: All patients admitted with pleural effusion in the department of medicine were included in the study. All these patients were subjected to detailed clinical history regarding their presenting complaints, other symptoms like breathlessness, chest pain, cough with sputum production, fever, weight loss, loss of appetite were enquired. Other symptoms of cardiac, liver or renal failure like swelling of feet, abdominal distension, oliguria were also enquired. Past history of any pulmonary tuberculosis, any history of previous intake of anti tuberculosis treatment, history of diabetes or any other significant illnesses, contact history with tuberculosis were obtained. Detailed clinical examination was carried out and routine investigations like Hemoglobin, ESR, Mantoux testing were done for all patients. Chest X ray PA view, Lateral decubitus view were also taken. CONCLUSION: 100 cases of pleural effusion admitted in the medical wards of Stanley Medical college, Chennai were investigated and the following conclusions were made. 1. The spectrum of etiological causes ranges from Tuberculosis to Hypoalbuminemia. 2. The most common cause of pleural effusion is Tuberculosis (50%) followed by congestive cardiac failure (11%). 3. The peak age of incidence of overall pleural effusion is between 21-40 years. The peak age of Tuberculous effusion is between 21-40 years of age. 4. Most common symptom of overall pleural effusion is Dyspnoea (70%). 5. Most common symptom of tuberculous pleural effusion is Pleuritic chest pain (70 %) followed by Dyspnoea (66%). 6. Right sided effusions (50%) are more common. 7. Rare causes of Pleural effusions noted in this study are: • Papillary serous cystadenocarcinoma of ovary. • Pulmonary thromboembolism. • Collagen vascular diseases-RA and SLE. • Post cardiac surgery. • Aortic aneurysm. • Hypothyroidism