Unilateral Left Pleural Effusion among Patients
with Liver Cirrhosis ,Congestive Heart Failure and
Nephrotic Syndrome

Gam...
Introduction
Distinguishing an exudate from a
transudate is the first step in the
diagnostic approach of a patient
with pl...
Patients and Methods
This study included 320 patient with
congestive heart failure, 214 with liver
cirrhosis and 94 with n...
Patients and Methods
All patients were subjected to:
1-Detailed history taking.
2-Complete clinical examination.
3-Chest X...
Patients and Methods
5-Diagnostic thoracentesis
6-Serum sample:
7-All investigations for detection of
aetiology of pleural...
The criteria analyzed for discrimination
between transudates and exudates were:
1-Classical, Abbreviated and modified Ligh...
Table1:Type and side of pleural effusion among patients with
congestive heart failure during the period of this study

Con...
Table2:Type and side of pleural effusion among patients with
liver cirrhosis during the course of this study

Liver cirrho...
Table3:Type and side of pleural effusion among cases with
nephrotic syndrome during the period of this work
Nephrotic synd...
Aims of the Work and Results
The first objective was:

1-to assess the diagnostic value of
the new biochemical criteria
pr...
Figure1:Sensitivity, specificity and accuracy of different
biochemical parameters in identifying exudates:

Bilirubin rati...
The second Aim
2-to evaluate the effect of diuretic
therapy on different biochemical
parameters among
transudative
pleural...
Diuretics had a significant action on
light’s
criteria
that
leaded
to
misclassification of
trasudates into
pseudoexudates ...
The Third Aim
3- to identify the aetiology of left
exudative pleural effusion among
patients with liver cirrhosis, heart
f...
Figure2:Etiology of unilateral left pleural effusion
among cases of congestive heart failure:

Collagen disease

Malignanc...
Figure3:Etiology of unilateral left pleural
effusion among patients with liver cirrhosis:

Collagen disease
Pneumonia
Mali...
Figure 4:Etiology of unilateral left pleural
effusion among patients with nephrotic
syndrome:
Tuberculosis
Malignancy
Pneu...
Conclusions
1-SPAG is the most sensitive and
specific parameter in separation
between exudates and transudates.
2-Light’s ...
3-Classical , abbreviated and modified Light’s
criteria have the same sensitivity and
specificity in segregating exudates ...
6-The most common cause for unilateral left
exudative pleural effusion is pulmonary
embolism among cases of congestive hea...
Unilateral pleural effusion in liver cirrhosis, congestive heart failure and nephrotic syndrome
Unilateral pleural effusion in liver cirrhosis, congestive heart failure and nephrotic syndrome
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Unilateral pleural effusion in liver cirrhosis, congestive heart failure and nephrotic syndrome

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Unilateral pleural effusion in liver cirrhosis, congestive heart failure and nephrotic syndrome

  1. 1. Unilateral Left Pleural Effusion among Patients with Liver Cirrhosis ,Congestive Heart Failure and Nephrotic Syndrome Gamal Rabie Agmy, MD, FCCP Professor of Chest Diseases, Assiut University
  2. 2. Introduction Distinguishing an exudate from a transudate is the first step in the diagnostic approach of a patient with pleural effusion.
  3. 3. Patients and Methods This study included 320 patient with congestive heart failure, 214 with liver cirrhosis and 94 with nephrotic syndrome. All patients had pleural effusion. Out of these, 35 patients with congestive heart failure, 38 with liver cirrhosis and 24 with nephrotic syndrome had unilateral left sided pleural effusion. .
  4. 4. Patients and Methods All patients were subjected to: 1-Detailed history taking. 2-Complete clinical examination. 3-Chest X-ray both posteroanterior and lateral views. 4-Chest and abdominal sonography.
  5. 5. Patients and Methods 5-Diagnostic thoracentesis 6-Serum sample: 7-All investigations for detection of aetiology of pleural effusions among cases suspected to have exudative effusion.
  6. 6. The criteria analyzed for discrimination between transudates and exudates were: 1-Classical, Abbreviated and modified Light’s criteria. 2-Pleural fluid cholesterol. 3-P/S cholesterol ratio. 4-Pleural cholinesterase. 5-P/S cholinesterase ratio. 6-P/S bilirubin ratio. 7-Serum-pleural albumin gradient (SPAG).
  7. 7. Table1:Type and side of pleural effusion among patients with congestive heart failure during the period of this study Congestive heart failure Type of effusion Right Left No of % patients Bilateral Transudative 130 (40.6%) 3 (0.9%) 82(25.6%) 215 67.1% Exudative 56 (17.5%) 32 (10%) 17(5.4%) 105 32.9% Total no of patients % 186 (58%) 35 (11%) 99(31%) 320 100%
  8. 8. Table2:Type and side of pleural effusion among patients with liver cirrhosis during the course of this study Liver cirrhosis Type of effusion Right Transudative Exudative Total no of patients (%) Left 110(51.4%) 4(1.9%) 17(7.9%) % Bilateral 35(16.4%) 34(15.9%) 14(6.5%) 127(59.3%) 38(17.8) No of patients 49(22.9%) 149 69.6% 65 30.4% 214 100%
  9. 9. Table3:Type and side of pleural effusion among cases with nephrotic syndrome during the period of this work Nephrotic syndrome No of Patients Type of effusion Right Left Transudative 22 (23.4%) 2 (2.1%) Exudative 8 (8.5%) Total no of patients % Bilateral 40 (42.6%) 22 (23.4%) 0 30 (31.9%) 24 (25.5) % (0%) 40 (42.6%) 64 68.1% 30 31.9% 94 100%
  10. 10. Aims of the Work and Results The first objective was: 1-to assess the diagnostic value of the new biochemical criteria proposed to discriminate pleural transudates from exudates.
  11. 11. Figure1:Sensitivity, specificity and accuracy of different biochemical parameters in identifying exudates: Bilirubin ratio Cholinesterase ratio Clolesterol ratio SPAG Light criteria 0 20 40 Sensitivity 60 80 Specificty 100 Accuracy 120
  12. 12. The second Aim 2-to evaluate the effect of diuretic therapy on different biochemical parameters among transudative pleural effusion.
  13. 13. Diuretics had a significant action on light’s criteria that leaded to misclassification of trasudates into pseudoexudates in 50 cases of congestive heart failure,44 cases of liver cirrhosis and 30 cases of nephrotic syndrome. On the other hand, diuretics had insignificant action on other parameters.
  14. 14. The Third Aim 3- to identify the aetiology of left exudative pleural effusion among patients with liver cirrhosis, heart failure and nephrotic syndrome.
  15. 15. Figure2:Etiology of unilateral left pleural effusion among cases of congestive heart failure: Collagen disease Malignancy Pneumonia Pulmonary embolism Transudative effusion 0 10 20 30 40 50 60 70
  16. 16. Figure3:Etiology of unilateral left pleural effusion among patients with liver cirrhosis: Collagen disease Pneumonia Malignancy Tuberculosis Transudative effusion 0 10 20 30 40 50 60
  17. 17. Figure 4:Etiology of unilateral left pleural effusion among patients with nephrotic syndrome: Tuberculosis Malignancy Pneumonia pulmonary embolism Transudative effusion 0 10 20 30 40
  18. 18. Conclusions 1-SPAG is the most sensitive and specific parameter in separation between exudates and transudates. 2-Light’s criteria should not be used for differentiation between exudates and transudates in patients under diuretic therapy.
  19. 19. 3-Classical , abbreviated and modified Light’s criteria have the same sensitivity and specificity in segregating exudates from transudates. 4-Cholinesterase had a poor diagnostic yield in detection of transudates in liver cirrhosis. 5-Unilateral left trasudative pleural effusion is rare among cases of congestive heart failure, liver cirrhosis and nephrotic syndrome.
  20. 20. 6-The most common cause for unilateral left exudative pleural effusion is pulmonary embolism among cases of congestive heart failure and nephrotic syndrome, while, TB is the major contributory disease in liver cirrhosis. 7-Ultrasonography is more sensitive in detection of pleural effusion than plain chest radiograph especially in small sized and subpulmonic effusions.

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