Hira H S, Ranjan Rajiv
Department of Pulmonary and Internal Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi - 110 002, India.
Lung India. 2011 Apr;28(2):101-4. doi: 10.4103/0970-2113.80319.
Sometimes etiological diagnosis of pleural effusion is difficult despite cytological, biochemical and microbiological tests and labeled as undiagnosed exudative pleural effusions.Aim of present study was to make an etiological diagnosis of pleural effusion.
Study group included patients of exudative pleural effusion where etiological diagnosis could not be yielded by conventional cytological, biochemical and microbiological investigations. Pleural tissue was obtained by Cope's pleural biopsy needle and or thoracoscopy. Pleural biopsy was subjected to histopathology, ZN staining and culture to find the mycobacterium tuberculosis.
Out of 25 patients, 17 (68%) and 8 (32%) were male and female, respectively. Age ranged from 15 to 65 years (mean 31.72). Mean value of serum and pleural fluid LDH was 170.56 U/L and 1080.28 U/L, respectively. Histopathology of 9 (36%) showed epitheloid granuloma with caseation necrosis. In other 9 (36%) patients, epitheloid granulomas (with or without giant cells) was reported. In 5 (20%) patients, histopathology report was of nonspecific chronic inflammation. Histopathology was reported as normal in one case; it turned out to be a case of malignancy. In two (8%) patients, pleural tissue obtained was inadequate for opinions; however, other tests revealed malignancy in one and tuberculosis in other. Ziehl-Neelsen (ZN) stain was positive for AFB in two patients and culture of pleural tissue showed presence of Mycobacterium tuberculosis in three patients.
The role of percutaneous closed needle biopsy of pleura among patients of undiagnosed exudative pleural effusion is still accepted as a diagnostic tool, as this may lead to a specific diagnosis among 76% of cases. This is of particular importance in a developing country like India where the facilities of thoracoscopy and imaging guided cutting needle biopsies are not easily available.
尽管进行了细胞学、生化和微生物学检查，但有时胸腔积液的病因诊断仍很困难，被标记为未确诊的渗出性胸腔积液。本研究的目的是对胸腔积液进行病因诊断。
研究组包括渗出性胸腔积液患者，这些患者通过传统的细胞学、生化和微生物学检查无法得出病因诊断。通过科普氏胸膜活检针和/或胸腔镜获取胸膜组织。对胸膜活检进行组织病理学检查、抗酸染色和培养以发现结核分枝杆菌。
25例患者中，男性17例（68%），女性8例（32%）。年龄范围为15至65岁（平均31.72岁）。血清和胸腔积液乳酸脱氢酶的平均值分别为170.56 U/L和1080.28 U/L。9例（36%）的组织病理学显示上皮样肉芽肿伴干酪样坏死。在其他9例（36%）患者中，报告有上皮样肉芽肿（有或无巨细胞）。5例（20%）患者的组织病理学报告为非特异性慢性炎症。1例患者的组织病理学报告正常；结果为恶性肿瘤。2例（8%）患者获取的胸膜组织不足以给出诊断意见；然而，其他检查显示1例为恶性肿瘤，另1例为结核病。两名患者的萋-尼（ZN）染色抗酸杆菌阳性，胸膜组织培养显示3例患者存在结核分枝杆菌。
对于未确诊的渗出性胸腔积液患者，经皮胸膜闭式针吸活检的作用仍被视为一种诊断工具，因为这可能在76%的病例中得出明确诊断。在像印度这样的发展中国家，这一点尤为重要，因为那里胸腔镜和影像引导切割针吸活检的设备不容易获得。
