Percutaneous needle pleural biopsies in pleural effusion of uncertain aetiology in a Nigerian teaching hospital.

Clinical observation shows that most of the patients with pleural effusion of undetermined aetiology in a Nigerian teaching hospital receive antiTB drug trials. This observation prompted the authors to evaluate the role of percutaneous needle pleural biopsy as a diagnostic tool in effusions of uncertain aetiology. Thirty-seven patients with pleural effusion of uncertain aetiology were investigated by percutaneous pleural biopsies using Abrams pleural biopsy needle over an 18-month period. In 34, the aetiology was established giving a sensitivity of 92%. Non-specific pleurisy/empyema remains the commonest cause of effusion (41%), followed closely by malignancies (29.4%) and TB pleurisy (22%), respectively. Percutaneous needle pleural biopsies establish diagnosis of malignancy in 91% of the cases with 72% of the malignancies originating from the lung. There is a significant association between malignancy and pleural effusion of uncertain aetiology in patients above 40 years of age (P = 0.022). The empirical use of antiTB drugs in the absence of investigative results suggestive of the diagnoses should be discouraged. Instead concerted effort should be made to establish the cause of such effusion.