PLEURAL EFFUSION: A RATIONALE APPROACH TO DIAGNOSIS AND MANAGEMENT.

Background: Pleural effusion is a most common pleural disorder which can be due to multiple underlying pulmonary or systemic causes. The management of pleural effusion is based on history, clinical. radiologic and then analysis of pleural fluid with complete biochemical, cytologic, microbiological, histopathological examination. As a protocol the Lights criteria was applied to distinguish transudate and exudate effusion. The management also depends up on underlying disease for that acquisition of histopathological biopsy sample is required with use of precise and selective diagnostic tool. Results: Study included 103 cases of pleural effusions, predominantly middle aged individuals with a mean age of 45.6 years. Males constituted the majority at 74.8%, reflecting a male predominance in the affected population. Cough (75.7%), breathlessness (73.8%), and chest pain (65.0%), were the main symptoms. The predominant etiology in the study population was TB (49%), followed by malignant effusions (19%) and Syn-pneumonic effusions in 17% accounted 17% of cases. Diagnostic and therapeutic procedures such as pleurocentesis (96%), intercostal drain (ICD) insertion (32%), and the therapeutic procedures i.e. fibrinolytic, adhesion and septation removal, and pleurodesis (24%) were also performed. The diagnostic yield improved with the use of simirigid thoracoscope and fiberptic bronchoscopy by 13% and 12% respectively. have become more acceptable and popular tool since past decade. Discussion: The clinical examination and chest x-ray (CXR) are the simplest way to detect PLEF. Apart from the examination of PLEF for bio/ cyto/ microbs, the acquisition/ procurement of tissue for histological analysis becomes mandatory especially for undiagnosed cases. There are two known options for tissue biopsy: 1) a blind/ or closed pleural biopsy (CPB) with Abrams or Tru-cut needle and 2) a ‘gold standard’ surgical biopsy. However the USG guided pleural interventions are safe, cost effective, least invasive, radiation free and can be performed bed site with a comparable yield, where ever the computed tomography and thoracoscopy facilities are lacking