Role of Pleural Biopsy in the Etiological Diagnosis of Exudative Pleural Effusion

Abstract

Introduction:   Pleural effusion is a common clinical problem in developed as well as developing countries like Pakistan. Pleural effusions are grossly classified as either exudative or transudative. Tuberculosis, mali-gnancy and empyema are common causes of exudative pleural effusion, less common being pulmonary embo-lism and connective tissue disorders. Despite the mag-nitude of the problem, the exudative pleural effusion presents a common diagnostic problem. In the western countries malignancy and empyema are common cau-ses of exudative pleural effusion where as in Pakistan tuberculosis is the most frequent one.

Objective:  The objective of this study is to observe the role of pleural biopsy in the etiological diagnosis of exudative pleural effusion.

Design:  Cross - sectional study.

Setting:  Institute of Chest Medicine, King Edward Medical University / Mayo Hospital Lahore.

Material and Method:  One hundred and thirty diag-nosed patients of exudative pleural effusion (according to Light's criteria) were included in this study. Pleural fluid was sent for total leucocyte count, differential leucocyte count, biochemistry, Gram's staining and culture, AFB smear and culture, and malignant cyto-logy. Pleural biopsy was done in all the cases.

Results:  Out of 130 cases of exudative pleural effu-sion, adequate sample of pleural biopsy was taken in 118 (90.7%) patients. In 12 (9.7%) patients sample of pleural biopsy was inadequate. Out of which 52 pati-ents (44.06%) had granulomatous inflammation most likely tuberculosis, 19 patients (16.10%) had mali-gnancy, 14 patients (11.86%) had chronic empyema and in 33 patients (27.96%) there was non-specific in-flammation.

Conclusion:  Pleural biopsy is a valuable tool in the diagnosis of exudative pleural effusions especially in developing countries like Pakistan where more sophis-ticated investigations like thoracoscopy are not widely available.

Key words:  Pleural effusion, Pleura, Exudates, transu-dates, Tuberculosis.