04 Arijitd Medicine Introduction

INTRODUCTIO N

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leural effusion is a common complication of many disease processes either local or systemic. Pleural effusion refers to excess pleural fluid formation from the

parietal pleura or the interstitial spaces of lung or secondarily from peritoneal cavity or when there is decrease fluid removal by the lymphatics. The first step in the approach to a patient with pleural effusion is to determine whether the effusion is transudative or exudative. A transudative effusion occurs when systemic factors that influence the formation and absorption of fluid are altered and an exudative effusion occurs when local factors influencing the formation and absorption are altered. The most common cause of transudative pleural effusion is congestive heart failure (60 to 70%; Glazier J B et al), cirrhosis of liver and ascites (5%; Lieberman F L et al 1966 & Lieberman 1970). In many parts of the world the most common cause of an exudative pleural effusion is tuberculosis. Malignant pleural effusion secondary to metastasis are second most common (75% of all malignant pleural effusion are lung carcinoma, breast carcinoma and lymphoma) (Richard W Light, 2001). An extensive diagnostic work up is needed in cases with exudative effusion to know the cause (Light et al 1972). For these various parameters were evaluated but until recent time the Light criteria established in 1972, was found to distinguish exudative plural effusion from transudative pleural effusion. However in the recent years several reports indicated that these criteria misclassified a number of pleural effusions and for this several parameters were assessed, nevertheless all these alternatives falsely classified

 INT RODU CTI ON 

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some effusions and their superiority with respect to light's criteria is therefore insignificant. In 1990 Roth et al assessed the diagnostic value of serum – pleural effusion albumin gradient with a cut off value of 1.2 gm/dl to differentiate exudative and transudative pleural effusion and obtain the specificity of 100% compared with 72% with Light's criteria. Controversies exist as to the parameter or parameters applicable to differentiate exudative and transudative pleural effusion and for this various research work are going .on to find a accurate cheap parameter to correctly classify the transudative and exudative effusion.

AIMS AND OBJECTIVES: 

To study the significance of serum–effusion albumin gradient in the differential diagnosis of pleural effusion.



To compare serum–effusion albumin gradient to Light’s traditional criteria for disgnosing transudative or exudative pleural effusion.

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