Abstract

Pleural effusions contribute to a significant proportion of cases coming to pulmonary medicine OPD or casualty. Pleural effusion constitutes an important differential diagnosis of any abnormal chest radiograph. Homogenous opacities on chest radiograph with or without parenchymal infiltrates, mass lesions represent pleural fluid. Objectives 1. To study the role of biochemical analysis in cases with exudative pleural effusion. 2. To study the role of cytology in exudative pleural effusions. 3. To study the role of ADA in exudative pleural effusion cases. 4. To study the role of CBNAAT in exudative pleural effusion cases. Material and Methods Study Design: Prospective hospital based observational study. Study Area: The study was carried out in the Department of Pulmonary Medicine, Government Medical College & Government General Hospital, Kadapa, Andhra Pradesh. Study Period: June 2022 to November 2022. Study population: The study was carried out in 100 consecutive patients with exudative pleural effusions. Sample Size: Study consisted of 100 subjects. Sampling Method: Simple random Sampling Technique. Study tools and Data collection procedure: A complete clinical, general and physical examination was done on all patients. A chest radiograph Postero-anterior view was taken andeffusion amount was estimated. Effusion occupying 1/3rd of volume – mild effusion. Effusion occupying more than 1/3rd and less than 2/3rd of volume –moderate effusion Effusion occupying more than 2/3rd of volume – massive effusion Patient is subjected to other investigations like CBP, RFT, LFT, serum electrolytes, total leukocyte count (TLC), differential count (DC), viral markers, RBS, Serum proteins, sputum CBNAAT, pleural fluid CBNAAT, pleural fluid ADA, pleural fluid cytology, biochemical analysis and cell block for malignant cells. An informed consent was taken from patients in their native language regarding thoracocentesis. Results: There were 52 tubercular effusion cases in our study. Among them, 6 cases had raised ADA above 40 and pleural fluid CBNAAT detection for mycobacterium. 40 of them had ADA above cut off value but mycobacterium was not detected. Mycobacterium was detected among 3cases who had borderline raised ADA but less than 40 IU/L. Conclusion: Pleural effusions are more commonly encountered in pulmonary and medical practices in our country. The most common is tubercular effusions as shown in our study. All cases should undergo ultrasonography of chest along with routine chest x-ray. Fluid has to be aspirated under sonography guidance.

Description