Efficacy of pleural needle biopsy and pleural fluid
cytopathology in the diagnosis of malignant neoplasm involving the pleura.
Among tubercular cases 151 (87.8% of same group) had straw-colored pleural fluid
, 12 (7% of same group) had hemorrhagic pleural fluid
but in malignant cases 22 (62.9% of same group) cases had hemorrhagic pleural fluid
, and 13 (37.1% of same group) had straw-colored pleural fluid
ADA levels exhibited a significant P value (Dunn's test, P < 0.05) in patients with tuberculosis versus adenocarcinoma, as well as parapneumonic and transudative pleural fluid
. However, the P value according to Dunn's test was not significant (P > 0.05) for tuberculosis versus other pleural fluids
: mainly empyemas, lymphomas, and squamous-cell carcinomas (Table 2).
The pleural fluid
is classically malodorous, dark red to brown as in our patient .
The diagnosis of UT requires a diagnostic thoracentesis demonstrating pleural fluid
with an average pleural fluid-to-serum creatinine ratio > 1.00 [8, 9].
Besides being gold standard for pleural fluid
localization, TUS has now a superior role for identification of pneumothoraces in a supine trauma patient or patients in intensive care unit, compared to conventional chest radiography4.
'Pleural' tumours are found in the cavity between the lungs and chest wall that contains lubricating pleural fluid
Mycobacterium tuberculosis is isolated in culture in only 20% to 40% of cases of confirmed tuberculous pleuritis, the diagnostic yield of the culture being low in pleural fluid
, but may be increased if a sample of pleural tissue is also cultured (6,8,9).
We routinely proceeded with the following investigations, which included AFB smear and culture of sputum (2 to 3 sets), pleural fluid
and pleural tissue, and histology of pleural tissue, in all patients suspected of mycobacterial empyema.
Thoracentesis was performed and pleural fluid
analysis revealed a transudative fluid consistent with hepatic hydrothorax.
analysis showed a predominance of lymphocytes (90%) and a lactate dehydrogenase level of 120 U/L, glucose of 157 mg/dL, protein of 4.8 g/dL, amylase of 39 U/L, and triglycerides of 405 mg/dL.
Thoracentesis yielded 1.5 liters of tea-colored exudate containing 2800 nucleated cells/mL--63% lymphocytes and 37% neutrophils--and a pleural fluid
to serum protein ratio >0.5.