Aziz Ahmad, Ahmad Zeb Khan, Bilal Ahmad, Fazli Rabbi, Yasir Ahmad.
Diagnostic outcome of large and massive Plueral effusion.
Pak J Chest Med Jan ;14(4):4-10.

The primary objective of this study was to report the diagnostic outcome of all pleural effusions and compare the etiology of large and massive effusions. The secondary objective was to compare the biochemical characteristics of different sizes of effusions, in relation to diagnostic outcome. Design: Retrospective chart review of all patients undergoing thoracentesis at Saidu teaching Hospital Saidu Sharif, during five years period. Methods: The size of the effusion was assessed on the postero anterior radiograph by visually estimating the area of the hemithorax occupied by pleural fluid. Diagnostic thoracentesis report was available on all the cases that included RBC count, leukocyte count, percentage of neutrophils, lymphocytes and cytology. Biochemical tests included, glucose level, protein level, lactate dehydrogenase (LDH) level, pH, fluid/serum protein ratio, and fluid/serum LDH ratio. Pleural biopsies were performed on selected cases. Results: Among 388 screened cases of pleural effusion 108 had either large or massive effusion and 280 cases had non- large effusion. Large pleural effusions (two thirds or more of the hemi thorax) were found in 68 cases and massive effusions (entire hemi thorax) in 40 cases. There was a similar etiological spectrum between large and massive pleural effusion. The most frequent cause of these pleural effusions was tuberculosis; in 40 patients (37%) followed by malignancy in 31 (29%), and complicated parapneumonic effusion in 19 patients (18%). Among massive effusions, malignancy was most frequent (15 patients: 38%). Compared with non-malignant pleural effusions, patients with large or massive malignant pleural effusions were more likely to have pleural fluids with higher RBC counts (18.0 109cells/L vs. 2.7 109cells/L, respectively; p < 0.001). Compared with non-large effusions, large and massive malignant pleural effusions showed higher median RBC counts (18.0x109cells/L vs. 4.3x109cells/L, respectively; p < 0.001), higher lactate dehydrogenase levels (641 vs. 409 U/L, respectively; p 0.001), lower pH (7.39 vs. 7.42, respectively; p 0.006) Conclusions: The presence of a large or massive pleural effusion enables the clinician to narrow the differential diagnosis of pleurisy, since most effusions are secondary to malignancy or infections (either bacterial or mycobacterial). Bloody pleural fluid are likely to favor malignancy.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com