Clinical and histopathological profile of patients with exudative pleural effusion of unknown cause who undergo medical thoracoscopy

Abstract

Background: Exudative lymphocytic effusions form a significant proportion of undiagnosed pleural pathologies. This study explores the clinical and histopathological profile of exudative pleural effusion of unknown cause who undergo medical thoracoscopy.

Materials And Methods: This cross-sectional study enrolled 37 patients with exudative pleural effusion. Ultrasound-guided thoracentesis was conducted and samples were sent for pleural fluid cytology. Thoracoscopic pleural biopsy was kept as the gold standard.

Results: A total of 37 patients were included in the study. 14 (37.83%) were smokers. 19 (51.35%) were exposed to firewood smoke. Only 1 participant (2.7%) reported exposure to passive smoke.5 patients had STEMI/ recent CABG in the last 1 year.1 participant reported a history of Ayurvedic drug intake. There was no asbestos occupational exposure in any of our subjects but 5 of our subjects had mesothelioma. It can be related to an indirect exposure which is absent due to a recall bias. 2 participants reported a history of recent trauma or RTA, but it was unrelated to the final diagnosis. Histopathological profile showed adenocarcinoma in 19(51.35%), tuberculosis in 7(18.9%).Thoracoscopy pleural findings include nodules in 26(70.27%).

Conclusion: Our study concluded that pleural nodules on thoracoscopy were suggestive of malignant aetiology with good cytology yield. Pleural metastasis from lung adenocarcinoma has a good yield of cytology and is the most common cause of exudative pleural effusions that underwent medical thoracoscopy.