Review Analysis Of Etiology In 154 Cases Inpatients With Pleural Effusion

The pleural effusion is generally witnessed in clinical practice. Accurate discrimination between benign and malignant pleural effu- sion is very important for treatment and prognosis.Objective To investigate the etiology and clinical character of pleural effusion and improve the efficiency of diagnosis and different- ial diagnosis.Methods We made a retrospective analysis of 154 cases inpati- ents with pleural effusion from Aug. 2005 to Dec. 2007. There were 84 male and 70 female patients with an average age of 57.62 years.Results In 94 cases with malignant pleural effusion, 74 patien- ts(78.7%) were adenocarcinoma. In 60 cases of pleural effusions with benign origin, 39 cases (25.3 %) were caused by tuberculosis, 13 cases (8.4 %) were caused by heart failure, 5 cases (3.2 %) were due to pne- umonia and 3 cases were attribute to hypoproteinemia. Among patien- ts under 45 years (including 45 years old), tuberculous pleuritis was major reason for pleural effusion; in patients between 46 and 60 years old and over 60 years old, most pleural effusion were finally diagnos- ed to be malignant pleural effusion (72.8%,67.2%). In a larger sense, most cases of pleural effusion were located in right chest. The detecti- on rate of carcinoma cells in exudates with blood effusion was signify- cantly higher than that in exudates with non-blood effusion(P<0.05). The level of dehydrogenase (LDH) in malignant pleural effusion incr- eased obviously and was significantly higher than the level in tuber- culous pleural effusion(P<0.05). The positive incidence of cancer cell in pleural effusion was 64.2%(43/67) and 13.3%(10/75) in phlegm. The rest cases, among which 28 cases were inspected by transbron- chial lung biopsy, 8 were detected by lymph follicle needle aspiration biopsy and 5 were discovered by CT-guided percutaneous needle aspiration biopsy of lung. The overall incidence of above three items was positive.Conclusion Tuberculosis and malignant tumor are the major causes of pleural effusion. Tuberculosis is the most important etiologic factor for pleural effusions in younger patients. For the elder over 45 years old, malignant tumor is the most important etiology. The onset age of tuberculosis tends to be postponed gradually. Pleural effusion was mainly unilateral, especially in the right, possibly related to the anatomic structure of the lower respiratory tract. Malignant pleural effusion is rarely witnessed bilaterally. When exudates are detected, if the pleural effusion is bloody, malignant lesions are highly suspected. In malignant pleural effusion caused by bronchial lung carcinoma, the largest proportion in etymology is adenocarcinoma, squamous cell carcinoma can also be found sporadically.