Maji Arnab, Maikap Malay Kumar, Jash Debraj, Saha Kaushik, Kundu Abhijit, Saha Debabrata, Banerjee Sourindranath, Patra Anupam
Postgraduate Trainee, N.R.S. Medical College , Kolkata, West Bengal, India .
J Clin Diagn Res. 2013 Oct;7(10):2223-6. doi: 10.7860/JCDR/2013/6738.3476. Epub 2013 Sep 16.
Pleural effusion is a common problem encountered in daily practice. To Establish aetiology of exudative effusions is a diagnostic challenge to general practitioners and even to pulmonologists especially in resource poor government hospitals with lack of investigations like thoracoscopy. Some recent studies had shown that around 2% of patients remained undiagnosed even after these investigations.
To evaluate the role of the commonly available investigations such as pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopy in the aetiological evaluation of exudative effusions and to ascertain the proportion of cases which remain undiagnosed after all the above investigations.
This was a prospective single-centred cross-sectional study carried out at the NRS Medical College, Kolkata, India from February 2008 to February 2013 which included 568 patients of exudative pleural effusions. We performed commonly available procedures like pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopic procedures to the diagnosis.
Total number of patients studied were 568. Tuberculosis was the most common cause (54.57%) followed by malignancy (28.17%), empyema (10.56%), parapneumonic effusion (5.28%) and others. Carcinoma of the lung was the commonest cause of malignant effusions and bronchoscopic biopsy was given the highest yield of histological diagnosis (84.6%) followed by CT guided FNAC (77.6%) and pleural fluid cytology (55%). Highest yield to diagnose tubercular effusion was found in lymph node FNAC (81.5%) followed by pleural biopsy (62%). Sputum smear for AFB was positive in only 27.4% cases. Bleeding followed by pneumothorax were the most common complications. Complications are very less (1.3% and 0.9% respectively). 2 patients (0.34%) remained undiagnosed even after these all above said investigations.
Above mentioned commonly available investigations can ascertain diagnosis in most of the cases in the aetiological evaluation of exudative effusions and they are relatively safe procedures.
胸腔积液是日常医疗实践中常见的问题。确定渗出性胸腔积液的病因对全科医生甚至肺科医生来说都是一项诊断挑战，尤其是在资源匮乏、缺乏胸腔镜等检查手段的政府医院。最近的一些研究表明，即使经过这些检查，仍有大约2%的患者无法确诊。
评估胸腔积液检查、盲法胸膜活检、痰液检查、胸部CT扫描、支气管镜检查等常用检查在渗出性胸腔积液病因评估中的作用，并确定经过上述所有检查后仍无法确诊的病例比例。
这是一项于2008年2月至2013年2月在印度加尔各答的NRS医学院进行的前瞻性单中心横断面研究，纳入了568例渗出性胸腔积液患者。我们进行了胸腔积液检查、盲法胸膜活检、痰液检查、胸部CT扫描、支气管镜检查等常用诊断程序。
共研究了568例患者。结核病是最常见的病因（54.57%），其次是恶性肿瘤（28.17%）、脓胸（10.56%）、类肺炎性胸腔积液（5.28%）和其他病因。肺癌是恶性胸腔积液最常见的病因，支气管镜活检的组织学诊断阳性率最高（84.6%），其次是CT引导下细针穿刺抽吸活检（77.6%）和胸腔积液细胞学检查（55%）。诊断结核性胸腔积液的阳性率最高的是淋巴结细针穿刺抽吸活检（81.5%），其次是胸膜活检（62%）。痰涂片抗酸杆菌阳性的病例仅占27.4%。出血和气胸是最常见的并发症。并发症发生率很低（分别为1.3%和0.9%）。即使经过上述所有检查，仍有2例患者（0.34%）无法确诊。
上述常用检查在渗出性胸腔积液病因评估中的大多数病例中能够确定诊断，而且这些检查相对安全。
