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8/14/2019 07 ArijitD Medicine Results
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In the present study 75% cases were male and 25% were
females.
Pleural effusion affects either one or both sides. From the
present study the distribution of affection are shown in the Table3.
TABLE3
SHOWING THE DISTRIBUTION OF 40 CASES OF PLEURAL
EFFUSION AFFECTING ONE OR BOTH SIDES OF CHEST
SIDES OF
PLEURAL
EFFUSION
NUMBER
OF CASES
(N = 40 )
PERCENTAGE
(%)
Right 20 50.0
Left 12 30.0
Bilateral 8 20.0
Right sided pleural effusion was found in 50% of cases as
compared to 30% on left sides. Bilateral effusion was found in 20% of cases.
The patients of the present study were presented with various
symptoms which are shown in the following table.
TABLE4
SHOWING PRESENTING SYMPTOMS OF
THE 40 CASES OF PLEURAL EFFUSION
SYMPTOMS
NUMBER
OF CASES
(N = 40 )
PERCENTAGE
(%)
Breathlessness 35 87.5
Chest pain 21 52.5
Dry cough 26 65.0
Cough with expectoration 12 30.0
Fever 24 60.0
Night Sweat ]2 30.0
Hemoptysis 5 12.5
Others 18 45.0
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The commonest symptom of presentation was breathlessness
(87.5%). Dry cough and fever were present in 65% and 60% of cases
respectively.
The erythrocyte sedimentation rates (ESR) were examined in all
40 cases of pleural effusion and the findings are shown in the following table.
TABLE 5
SHOWING ESR OF 40 CASES OF PLEURAL EFFUSION
ESR(mmAEFH)
NUMBER
OF CASES(N = 40 )
PERCENTAGE(%)
010 1 2.5
1120 3 7.5
2130 6 15.0
3140 7 17.5
4150 4 10.0
5160 6 15.0
61 70 2 5.0
7180 1 2.5
8190 1 2.5
90100 4 10.0
> 100 5 12.5
In the present study 90% of patients had an ESR above 20 mm
AEFH.
Sputum was examined for cytology in all the 40 cases of pleural
effusion irrespective of parenchymal lesions present or absent and the results
are shown in the following table.
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TABLE6
SHOWING THE RESULTS OF CYTOLOGICAL EXAMINATION OF SPUTUM
SPUTUM EXAMINATION
NUMBER
OF CASES
(N = 40 )
PERCENTAGE
(%)
Positive Gram stain for Pyogenic bacteris
Positive ZiehlNeelsen Stain for AFB
Positive pap smear for malignant cells
Negative for pyogenic organism, AFB or malignant cells
2
5
4
29
5.0
12.5
10.0
72.5
In the present study only 27.5% of 40 cases of pleural effusion
had positive cytological examination of sputum for pyogenic organism, AFB
and malignant cells. All other patients had a negative cytology.
TABLE7
SHOWING THE RESULTS OF THE SKIAGRAM
OF CHEST OF PARENCHYMAL LESIONS ONLY
RESULTS OF THE
SKIAGRAM OF CHEST
NUMBEROF CASES
(N = 40 )
PERCENTAGE
(%)
Tuberculosis 8 20.0
Malignancy 3 7.5
Pneumonic consolidation 2 5.0
No lung parenchymal changes 27 67.5
In the present study 8 patients had tubercular lesions present inchest Xray and 3 had evidence of malignancy. Pneumonic consolidations
were seen in two patients. In 67.5% of the cases (27) had no associated lung
parenchymal changes.
The pleural fluids from the 40 cases of pleural effusions on
gross examination appeared as follows.
TABLE8
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SHOWING THE PLEURAL FLUID APPEARANCES
OF THE 40 CASES OF PLEURAL EFFUSION
PLEURAL FLUID
APPEARANCE
NUMBEROF CASES
(N = 40 )
PERCENTAGE
(%)
Pale Yellow 30 75.0
Hemorrhagic 7 17.5
Turbid 3 7.5
The pleural fluid appeared pale yellow coloured in 75% of cases
and hemorrhagic in 17.5% of cases. In other 7.5% cases the pleural fluid was
turbid.
The pleural fluid was examined for cytology in all 40 cases of
pleural effusion and the results obtained are shown in table 10.
TABLE 9
SHOWING THE RESULTS OF CYTOLOGICAL EXAMINATION
OF PLEURAL FLUID OF 40 CASES OF PLEURAL EFFUSION
Cells
NUMBER
OF CASES(N = 40 )
PERCENTAGE
(%)
Lymphocytes:
Few 29 72.5
Plenty 7 17.5
Pus Cells:
Few 12 30.0
Plenty 2 5.0
RBC's: Few 6 15.0
Plenty 7 17.5
In majority of cases (72.5%) the pleural fluid contained few
lymphocytes. Plenty of RBC's and pus cells were present in 17.5% and 5%
cases respectively.
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The pleural fluid was examined for AFB, malignant cells and
culture for pyogenic organism and result are shown in the following table.
TABLE11
RESULTS OF POSITIVE PLEURAL FLUID EXAMINATION FOR AFB,
MALIGNANT CELLS AND CULTURE FOR PYOGENIC ORGANISMS
Pleural fluid for
NUMBER
OF CASES
(N = 40 )
PERCENTAGE
(%)
Acid fast bacilli 4 10.0
Malignant cells 3 7.5
Culture for pyrogenic organism 2 5.0
The etiologic diagnosis could be made in 22.5% of cases. Acid
fast bacilli and malignant cells were demonstrated in 10% & 7.5% each and
pyogenic organism was isolated in 5% of cases. In 31 cases (77.5%) all the
smear studies were negative for AFB, malignant cells and culture for poygenic
organism.
Pleural biopsy was done in 11 cases of pleural effusion in thepresent study and the results are shown in the Table12.
TABLE 12
RESULTS OF THE PLEURAL BIOPSY IN
SELECTED CASES OF PLEURAL EFFUSION
PLEURAL BIOPSY
RESULTS
NUMBER
OF CASES
PERCENTAGE
(%)
Tuberculosis 8 20.0
Adenocarcinoma 2 5.0
Non Hodgkin's lymphoma 1 2.5
TOTAL 11 27.5
Pleural Biopsy was done in 11 cases & on comparing with the
etiological diagnosis of 40 cases of pleural effusion, 20% of biopsy came out
to be tuberculosis & 7.5% were malignancies.
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TABLE 13
THE CAUSES OF THE 40 CAUSES OF PLEURAL EFFUSION
CAUSESNUMBEROF CASES
(N = 40 )
PERCENTAGE
(%)
Transudates:
Heart failure
Cirrhosis
Nephrotic syndrome
Pericardial effusion
6
4
3
1
15.0
10.0
7.5
2.5
Exudates :
Tuberculosis
Neoplasm
Parapneumonic effusion
Rheumatoid Arthritis
15
8
2
1
37.5
20.0
5.0
2.5
Among the transudates 15% cases are caused by congestive
heart failure and 37.5% of exudates are caused by tuberculosis.
TABLE 14
PLEURAL FLUID PROTEIN CONCENTRATION
OF THE 40 CASES OF PLEURAL EFFUSION
PROTEIN
CONCENTRATION IN
PLEURAL FLUID
(g/dl)
NUMBER
OF CASES
(N = 40 )
PERCENTAGE
(%)
1.02.0
2.13.0
3.14.0
4.15.0
3
15
0
22
7.5
37.5
0.0
55.0
In 55% of cases pleural fluid protein concentrations were above
3 g/dl & in 45% the protein concentration was 3 or below 3 g/dl.
The graphical representation of the above table is shown in
Fig. 1.
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TABLE 15
SHOWING THE DISTRIBUTION OF PLEURAL FLUID
TO SERUM PROTEIN RATIO
PLEURAL FLUID
TO SERUM
PROTEIN RATIO
NUMBER
OF CASES
(N = 40 )
PERCENTAGE
(%)
0.010.25
0.260.50
0.510.75
0.761.00
0
17
17
6
0.0
42.5
42.5
15.0
In 57.5% of cases pleural fluid protein to serum protein was
above .5 & in 42.5% cases it was 0.5 or below 0.5
The graphical representation of the above table is shown in
Fig. 2.
TABLE16
SHOWING THE DISTRIBUTION OF PLEURAL FLUID LDH
PLEURAL
FLUID LDH
(U/L)
NUMBER
OF CASES
(N = 40 )
PERCENTAGE
(%)
0200
201400
401600
601800
16
3
16
5
40.0
7.5
40.0
12.5
In 60% of cases Pleural Fluid LDH is greater than 200 U/L & in
40% cases it is equal or less than 200 U/L.
The graphical representation of the above table is shown in
Fig. 3.
TABLE 17
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SHOWING THE DISTRIBUTION OF PLEURAL FLUID LDH TO SERUM LDH
PLEURAL FLUIDLDH/SERUM LDH
NUMBER
OF CASES(N = 40 )
PERCENTAGE(%)
0.000.30
0.310.60
0.610.90
0.911.20
1.211.50
2
11
10
6
11
5.0
17.5
25.0
15.0
27.5
In 67.5% of cases Pleural fluid LDH to serum LDH is above 0.6& in 32.5% it is equal or less than 0.6
The graphical representation of the above table is shown in
Fig. 4.
TABLE 18
SHOWING DISTRIBUTION OF SEAG [SERUMEFFUSION ALBUMIN
GRADIENT] IN 40 CASES OF PLEURAL EFFUSION
SEAG
NUMBER
OF CASES(N = 40 )
PERCENTAGE(%)
0.300.60
0.610.90
0.911.20
1.211.50
1.511.80
1.812.10
2.112.40
3
4
19
10
3
0
1
7.5
10
47.5
25
7.5
0
2.5
In 35% of cases SerumEffusion Albumin gradient is above 1.2
g/dl & in 65% of cases it is equal or less than 1.2 g/dl.
The graphical representation of the above table is shown in
Fig. 5.
TABLE 19
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SHOWING EXUDATES & TRANSUDATES SEPARATED BY PLEURAL
FLUID PROTEIN OF 3 gms/dl IN COMPARISON TO THE
ESTABLISHED DIAGNOSIS OF TRANSUDATES & EXUDATES
TYPES OF
PLEURAL
FLUID
ETIOLOGICALLY
DIAGNOSED
(N = 40)
NUMBER OF
CASES
DIFFERENTIATED
BY PLEURAL
FLUID PROTEIN
OF 3 g/dl
NUMBER
OF CASES
TRULY
CLASSIFIED
NUMBER OF
CASES
FALSELY
CLASSIFIED
Exudate
Transudate
26
14
22
18
16
14
6
4
The Pleural fluid Protein of 3g/dl separated 22 cases (55%) as
exudates & 18 (45%) as transudate. When etiology was reviewed 6 of the
exudates & 4 of the transudates were fa lsely classified. A total
misclassification of 25% occurred.
The graphical representation of the above table is shown in
Fig. 6.
TABLE 20
SHOWING EXUDATES & TRANSUDATES SEPARATED BY PLEURALFLUID PROTEIN TO SERUM PROTEIN OF .5 IN COMPARISON TO THE
ESTABLISHED. DIAGNOSIS OF TRANSUDATES & EXUDATES
TYPES OF
PLEURAL
FLUID
ETIOLOGICALLY
DIAGNOSED.
(N = 40)
NUMBER OF
CASES
DIFFERENTIATED
BY P/S PROTEIN
OF 0.5
NUMBER
OF CASES
TRULY
CLASSIFIED
NUMBER OF
CASES
FALSELY
CLASSIFIED
Exudate
Transudate
26
14
23
17
18
14
5
3
The pleural fluid to serum protein ratio of .5 separated 23 cases
(57.5%) as exudates & 17 (42.5%) as transudates. When etiology was
reviewed 5 of the exudates & 3 transudates were falsely classified. Total
misclassification of 20% occurred.
The graphical representation of the above Table20 is shown in
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Fig. 7.
TABLE 21
SHOWING EXUDATES & TRANSUDATES SEPARATED BY PLEURAL
FLUID PROTEIN OF 3g/dl & PLEURAL FLUID TO SERUM PROTEIN
RATIO OF .5 IN COMPARISON TO THE ESTABLISHED.
DIAGNOSIS OF EXUDATES & TRANSUDATES
TYPES OF
PLEURAL
FLUID
ETIOLOGICAL
DIAGNOSIS
(N = 40)
NUMBER OF
CASES
DIFFERENTIATED
BY P.F. PROTEIN
3g/dl & P/S OF 0.5
NUMBER OF
CASES
TRULY
CLASSIFIED
NUMBER OF
CASES
FALSELY
CLASSIFIED
Exudate
Transudate
26
14
22
18
18
15
4
3
Pleural fluid protein of 3g/dl & p/s of .5 separated 22(55%)
cases as exudates & 18(45%) as transudates. When the etiology was reviewed
4 of the exudates & 3 of the transudates were falsely classified. Total
misclassification rate of 17.55% occurred.
The graphical representation of the above table is shown in
Fig. 8.
TABLE 22
SHOWING EXUDATES & TRANSUDATES SEPARATED BY
PLEURAL FLUID LACTATE DEHYDROGENASE (LDH) OF 200 U/L
TYPES OF
PLEURAL
FLUID
AETIOLOGICAL
DIAGNOSIS
(N = 40)
NUMBER OF
CASES
DIFFERENTIATED
BY PLEURAL
FLUID LDH OF
200 U/L
NUMBER OF
CASES
TRULY
CLASSIFIED
NUMBER OF
CASES
FALSELY
CLASSIFIED
Exudate
Transudate
26
14
24
16
20
13
4
3
Pleural fluid LDH of 200 U/L separated 24 (60%) as exudates &
16 (40%) as transudates. When etiology was reviewed 4 of exudates & 3 of
transudates were falsely classified. Total misclassification of 17.5% occurred.
The graphical representation of the above Table22 is shown in
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Fig. 9.
TABLE 23
SHOWING EXUDATES AND TRANSUDATES SEPARATED BY PLEURAL
FLUID LDH TO SERUM LDH OF O.6 IN COMPARISON TO THE ESTABLISHED
DIAGNOSIS OF EXUDATES & TRANSUDATES
TYPES OF
PLEURAL
FLUID
AETIOLOGICAL
DIAGNOSIS
(N = 40)
NUMBER OF
CASES
DIFFERENTIATED
BY P/S LDH OF 0.6
NUMBER
OF CASES
TRULY
CLASSIFIED
NUMBER OF
CASES
FALSELY
CLASSIFIED
Exudates
Transudates
26
14
27
13
24
11
3
2
Pleural fluid LDH to Serum LDH of .6 separated 27 (67.5%) as
exudates & 13 (32.5%) as transudates. When the etiology was reviewed 3 of
the Exudates & 2 transudates were falsely classified. Total misclassification
of 12.5% occurred.
The graphical representation of the above table is shown in
Fig. 10.
TABLE 24
SHOWING EXUDATES & TRANSUDATES SEPARATED BY
PLEURAL FLUID LDH OF 200 U/L & PLEURAL FLUID LDH
TO SERUM LDH OF 0.6 IN COMPARISON TO THE
ESTABLISHED DIAGNOSIS OF EXUDATE & TRANSUDATE
TYPE OFPLEURAL
FLUID
ETIOLOGICALDIAGNOSIS
( N = 40 )
NUMBER OF CASES
DIFFERENTIATED BYPLEURAL FLUID LDH
OF 200 U/L &
P/S LDH OF 0.6
NUMBER
OF CASESTRULY
CLASSIFIED
NUMBER OF
CASESFALSELY
CLASSIFIED
Exudate 26 28 26 2
Transudate 14 12 10 2
Pleural fluid LDH of 200 U/L & pleural fluid LDH to serum
LDH of .6 seperated 28 ( 70% ) cases as exudates & 12 ( 30% ) as transudates
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when etiology was reviewed 2 of the exudates & 2 of the transudates were
falsely classified. Total misclassification of 10% occurred.
The graphical representation of the above table is shown in
Fig. 11.
TABLE 25
SHOWING NUMBER OF CASES SEPARATED BY SERUMEFFUSION
ALBUMIN GRADIENT OF 1.2 g/dl IN COMPARISON TO THE ESTABLISHED
DIAGNOSIS OF EXUDATES & TRANSUDATES
TYPE OF
PLEURAL
FLUID
AETIOLOGICAL
DIAGNOSIS
NUMBER OF CASES
DIFFERENTIATED
BY SEAG
OF 1.2 G/DL
NUMBER
OF CASES
TRULY
CLASSIFIED
NUMBER OF
CASES
FALSELY
CLASSIFIED
Exudate 26 26 25 1
Transudate 14 14 13 1
SerumEffusion Albumin gradient of 1.2 g/dl separated 26
(65%) cases as exudates & 14 (35%) as transudates when etiology was
reviewed only 1 exudate & 1 transudate was falsely classified. Total
misclassification of 5% occurred.
The graphical representation of the above table is shown in
Fig. 12.
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TABLE 26
MEAN (M) VALUES, RANGES (R), STANDARD DEVIATIONS (SD),
OF PARAMETERS STUDIED IN 40 CASES OF PLEURAL EFFUSIONS
Parameter CharacterTransudates(N = 14)
Exudates(N = 26)
Tubercular(N = 15)
Non
Tubercular(N = 2)
Neoplasm(N = 8)
Others(N = 1)
pvalue
PleuralFluid
Proteinof 3g/dl
M 2.534 4.344 3.33 3.78 3.69
R 1.923 4.184.69 1.924.69 2.734.63 2.414.52
SD 0.344 0.143 0.946 1.34 0.898
4.22