Source: Annual Congress 2002 - Pleural disease
Disease area: Respiratory infections, Thoracic oncology

Abstract

About one-quarter of exudative pleural effusions remain undiagnosed even after detailed clinical, radiological and pleural fluid analysis. These cases are often diagnosed by pleural biopsy or specialized pleural fluid biochemical tests.This study analyzed 90 cases of exudative pleural effusions diagnosed by pleural fluid adenosine deaminase (ADA) levels, closed Abrahams pleural punch biopsy and thoracoscopic pleural biopsy. Closed Pleural biopsy was diagnostic in 25 out of 45 cases. Among them 20 had tuberculosis and 5 had malignancy. In those 20 cases where closed pleural biopsy failed to yield diagnostic material thoracoscopic pleural biopsy established a diagnosis of tuberculosis in all of them. Thoracoscopic pleural biopsy as a primary procedure was diagnostic in 44 out of 45 remaining cases with 37 of them having tuberculosis and 7 having malignancy. Pleural fluid ADA level was found to be above 70 IU in 74 out of 78 cases of tubercular pleural effusions. In this study we observed that thoracoscopic pleural biopsy has the highest diagnostic utility in both tubercular and malignant effusions while conventional closed pleural biopsy is often unrewarding and high ADA levels in lymphocyte predominant pleural fluid are often diagnostic of tubercular etiology.

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M. B. N. B. Prasad, K. Shashirekha, S. C. Tiwari (Ranchi, India). In search of an ideal method to diagnose undetermined exudative pleural effusions. Eur Respir J 2002; 20: Suppl. 38, 536

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