Nitin Gadewad1, Kunal Deokar2, Shivhari Ghorpade3. 1. Senior Registrar, Fortis Hospital, Mumbai, Maharashtra. 2. Consultant Pulmonologist, Sapphire Hospitals, Thane, Maharashtra. 3. Professor and Head, Dept. of Pulmonary Medicine GMC, Nagpur, Maharashtra.
Abstract
BACKGROUND: Malignant pleural effusions are one of the leading causes of exudative pleural effusions. We studied the clinical profile of patients presenting with malignant pleural effusion, their cytological and histopathological features and the efficacy of pleurodesis in preventing recurrence. MATERIALS AND METHODS: 100 patients who were positive for malignant cells in pleural fluid cytology or pleural biopsy were recruited. After history and clinical examination, Chest radiographs, Computed tomography of chest were performed. After diagnostic thoracocentesis and Pleural biopsy, Tube thoracostomy was done. Pleurodesis was performed in 40 patients. RESULTS: Most of the patients (65%) were in the age group of 61 to 70 years with a male to female ratio of 1.5:1. Most common presenting symptoms were breathlessness (86%) and cough (86%). All (100%) of the malignant pleural effusions were exudative. Pleural fluid cytology was positive in 86% while pleural biopsy was positive only in 44%. Pleural biopsy was positive only in 17% of patients with negative cytology. Adenocarcinoma (59%) was the most common type of cytological diagnosis. Pleurodesis was performed in 40 patients of which 30% had recurrence. CONCLUSIONS: In our tertiary health care centre, malignant pleural effusions presented as large pleural effusions. Most common presenting symptoms were breathlessness and cough. They were exudative, lymphocytic predominant with low ADA levels. Thoracocentesis and cytologic study should be the initial diagnostic approach to malignant pleural effusions. Adenocarcinoma of the lung was the most common cause of malignant pleural effusion. Pleurodesis with oxytetracycline was successful in majority of cases.
BACKGROUND:Malignant pleural effusions are one of the leading causes of exudative pleural effusions. We studied the clinical profile of patients presenting with malignant pleural effusion, their cytological and histopathological features and the efficacy of pleurodesis in preventing recurrence. MATERIALS AND METHODS: 100 patients who were positive for malignant cells in pleural fluid cytology or pleural biopsy were recruited. After history and clinical examination, Chest radiographs, Computed tomography of chest were performed. After diagnostic thoracocentesis and Pleural biopsy, Tube thoracostomy was done. Pleurodesis was performed in 40 patients. RESULTS: Most of the patients (65%) were in the age group of 61 to 70 years with a male to female ratio of 1.5:1. Most common presenting symptoms were breathlessness (86%) and cough (86%). All (100%) of the malignant pleural effusions were exudative. Pleural fluid cytology was positive in 86% while pleural biopsy was positive only in 44%. Pleural biopsy was positive only in 17% of patients with negative cytology. Adenocarcinoma (59%) was the most common type of cytological diagnosis. Pleurodesis was performed in 40 patients of which 30% had recurrence. CONCLUSIONS: In our tertiary health care centre, malignant pleural effusions presented as large pleural effusions. Most common presenting symptoms were breathlessness and cough. They were exudative, lymphocytic predominant with low ADA levels. Thoracocentesis and cytologic study should be the initial diagnostic approach to malignant pleural effusions. Adenocarcinoma of the lung was the most common cause of malignant pleural effusion. Pleurodesis with oxytetracycline was successful in majority of cases.