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Dr Mazhar Ali, Dr Muhammad Wajid, Dr Haris Shakeel


Introduction: Pleural effusion remains the most common symptom of pleural pathology. It is sometimes difficult to distinguish tuberculosis from malignant pleural effusions on the basis of routine cytology and biochemistry. Therefore, a pleural biopsy is an important tool to evaluate undiagnosed pleural effusion. Aim: To understand the role of pleural biopsy in the diagnosis of unilateral pleural effusion. Methods: This observational study was conducted at the Medicine Unit-II of Jinnah Hospital Lahore for one-year duration from June 2019 to June 2020. All patients with unilateral pleural effusion over 15 years of age, regardless of gender, race, or religion, were included in the study. Results: A total of fifty cases were included in this study. The age of patients ranged from 16 to 78 years (mean ± SD, years: 47 ± 31.0). Thirty-six (72%) patients are male and fourteen (28%) are female. Nine patients (18%) were of higher socioeconomic status, 13 (26%) were lower class and 28 (56%) were middle class. Most of the patients (36%) are farmers, then 22% are businessmen, 18% are service users and 16% are housewives. Nineteen (38%) of the 50 patients were smokers and the non-smokers (62%) were non-smokers. Common complaints were fever (78%), respiratory failure (62%), cough (56%), chest discomfort (38%) and weight loss (32%). Overall results from a physical examination revealed that 62% had varying degrees of anemia followed by cystic fibrosis in 22% of cases. A respiratory examination showed that 56% of people had exudate on the left side and 44% on the right side. 36% show an offset of the trachea. Regarding the pleural fluid analysis, the color of the pleural fluid was straw colored in the majority of cases (42%) and sixteen cases (32%) had hemorrhagic fluid. The mean total number of cells in the pleural fluid was 1449.1 / c.mm. The majority (88%) had lymphocytes predominating. The mean pleural fluid protein content was 5.6 g / liter. Radiographic examination showed that the maximum number of patients (56%) had left-sided exudate and a total of 18 patients with a tracheal shift. Strict pleural biopsy for histopathological examination revealed up to (36%) different types of neoplasms, 24% chronic granulomatous inflammation corresponding to tuberculosis, 16% nonspecific chronic inflammation, and 24% of cases showed no abnormal results or no available or inadequate pleural tissue for the histological report. Out of all 18 cases of malignant neoplasms, 8 cases were diagnosed with adenocarcinoma, 3 cases with metastatic adenocarcinoma, 2 cases with non-Hodgkin's lymphoma, 2 cases with malignant mesothelioma, 3 cases with poorly differentiated cancer. Conclusion: Men dominate this study. Most of the respondents were non-smokers. The most common complaints were fever, respiratory distress, cough, chest discomfort and weight loss. Most of the general results of a physical examination are anemia and clubbing. The respiratory system revealed features indicative of pleural effusion (56% left and 44% right), 36% had a tracheal shift. In the majority (56%) of the studied population, the chest X-ray was a left pleural effusion. A strict pleural biopsy for histopathological examination revealed up to (36%) different types of neoplasms, followed by chronic granulomatous inflammation consistent with tuberculosis (24%).


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