[Pleural effusions—experience of Pneumo-phtisiology Hospital Tudor Vladimirescu—I: Clinical study]

Marian Olaru, Iancu Emil Pleşea, Dan Mălăescu, Rodica Olaru
Pneumologia: Revista Societății Române de Pneumologie 2008, 57 (3): 138-46
Pleural effusions still represent major problem of respiratory tract pathology because of the invalidity potential of pleural involvement and because of the increasing incidence of diseases frequently accompanied by pleural effusion such as tuberculosis and malignant pleural proliferations. The retrospective study concerned 221 cases with pleural effusions divided into three groups depending on the etiology (bacillary, neoplastic and others). Two categories of features were assessed: parameters assessed in the first 48 hours (epidemiological data, history data, clinical data, IDR and sedimentation rate) and parameters assessed after thoracentesis and/or pleural biopsy (LDH in pleural fluid and BK presence in pleural fluid and biopsy specimens). Bacillary etiology was dominating the studied group but possibly because the hospital was well known as a mainly antituberculous medical unit. The main profile of the investigated patients was: man, teenaged or adult, smoker and often alcoholic living in town. Clinical appearance was influenced by the triad: etiologic agent, age, amount of pleural fluid. Reduced amount of pleural fluid was related to acute onset, usually in young men and symptomatology dominated by thoracic pain. In contrast, massive pleural effusion was related with chronic onset, dyspnea and adult or old age. LDH and glyco-pleuria values are not pathognomic but useful for diagnostic orientation but if microscopic or culture evidence of BK in pleural fluid or tissue specimens are added, the diagnostic accuracy is increasing. In conclusion, a thorough clinical examination completed with a complex panel of laboratory investigations, including biochemical microbiological and special tests from pleural fluid and also a cytological examination could guide the diagnostic in establishing the type and the cause of pleural effusion.

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