Arshad Javaid, Muhammad Amjad, Nasir Shah, Abdul Samad, Zahoor Ullah.
Diagnostic evaluation of Exudative Pleural Effusion the value of Pleural Biopsy.
Pak J Chest Med Jan ;7(3):12-20.

Pleural effusion Is a common clinical and diagnostic problem. It is difficult to diagnose the underlying etiology on the basis of radiological findings, and clinical examination. We conducted a prospective study in collaboration with Pakistan Medical Research Council on patients with exudative pleural effusion, who presented to the chest unit in order to ascertain the underlying etiological causes for exudative pleural effusion and to establish the diagnostic yield of various investigative procedures performed in order to find the underlying cause of pleural effusion. We recruited 150 patients aged 16-80 years of either sex. All of them had pleural biopsy and pleural aspiration performed on them. Pleural fluid analysis provided definitive diagnosis in only 12 out of 150 patients (8%)where malignant cells were found in the pleural fluid. The diagnostic yield of pleural biopsy was 68.8%. In 67 patients (45%) histological examination of pleural biopsy revealed Tuberculosis, 36 patients (24%) had Malignancy and 47 patients (31 %) showed Chronic non specific pleuritis. We found that pleural biopsy is the most important and useful investigation to diagnose the cause of exudative pleural effusion. Pleural fluid analysis failed to differentiate between the two most common causes of exudative pleural effusion Le tuberculosis and malignancy in most of the patient. Age greater than 50, hemorrhagic pleural effusion (P<0.001) and co-existent pericardial effusion was in favour of malignant pleural effusion, while positive mantoux test (P<0.001) was in favor of tuberculous pleural effusion.

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