Pleural effusion: laboratory tests in 300 cases

Our plain-English summary of Pleural effusion: laboratory tests in 300 cases, by A. Hirsch, P. Ruffie, M. Nebut, et al (Thorax, 1979).

The study

• Authors: A. Hirsch, P. Ruffie, M. Nebut, J. Bignon, J. Chrétien
• Journal: Thorax
• Published: 1979;34(1):106-12
• Cited by: 146 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The cause of pleural effusion was studied in 300 consecutive patients by clinical examination and laboratory tests. The three most common causes were found to be cancer 117 cases (metastatic 65, bronchogenic 34, mesothelioma 10, lymphoma 7, other 1); tuberculous infection 53; and bacterial infection 38. The cause was not found in 62 patients. Cancer diagnosis was established by cytological examination of pleural fluid (63), closed pleural biopsy (37), and open pleural biopsy (11). Tuberculosis was diagnosed by culture of pleural fluid (12), closed pleural biopsy (38), and open pleural biopsy (3). In cases of empyema 12 Gram-positive and two Gram-negative cocci and two anaerobes were identified. The various causes and the usefulness of the different investigative procedures are discussed, and the data evaluated in the light of current knowledge about mechanisms of transfer through the pleural space.

In plain English

This French study followed 300 consecutive patients with pleural effusion (fluid around the lungs) admitted from October 1972 to October 1976. It aimed to find each effusion's cause and judge the laboratory tests. Records included occupational exposure, mainly to asbestos. A cause was found in 238 patients; in 62 it was not, even after full evaluation. Cancer was the most common cause, in 117 patients (39%): 65 metastatic, 34 bronchogenic (lung), 10 mesothelioma, 7 lymphoma and 1 other. Table 1 listed them as 9 men and 1 woman, with a scan-damaged note appearing to record asbestosis in 7 men. Tuberculous infection accounted for 53 patients and bacterial infection for 38. The table also listed 8 men under asbestosis as a cause. In cancerous effusions, fluid cell examination was positive in 54%, closed pleural biopsy in 40% and open biopsy in 78%. In tuberculous effusions, closed biopsy was positive in 88%. The readable text gave no mesothelioma-specific test results or asbestos exposure analysis, and the test-results table was unreadable. The authors concluded that tests on pleural fluid are very useful in diagnosing the cause.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: prospective survey (case series) of consecutive patients with pleural effusion, assessing causes and the usefulness of laboratory tests
• Who was studied: 300 patients (215 men, 85 women) admitted to thoracic disease departments in Creteil and Paris, France, between October 1972 and October 1976, all found to have fluid on thoracentesis
• Exposure: Not an exposure study. Occupational exposure, mainly to asbestos, was recorded for each patient, but the readable text reports no fiber types, jobs or doses and no analysis by exposure.
• Main results:
  • A cause was found in 238 of the 300 patients. It stayed undiagnosed in 62, even after full evaluation including open pleural biopsies in 15 patients.
  • Cancer was the most frequent cause, at 39% (117 patients).
  • The cancer cases were: metastatic 65, bronchogenic 34, mesothelioma 10, lymphoma 7, other 1.
  • Table 1 listed the 10 mesothelioma cases as 9 men and 1 woman. A garbled note in the men's column appears to record asbestosis in 7 of the men.
  • Tuberculous infection caused 53 effusions and bacterial infection caused 38.
  • Under other causes, Table 1 listed asbestosis in 8 patients, all men.
  • In cancerous effusions, cytological examination of the pleural fluid was positive in 54%, closed pleural biopsy in 40% and open pleural biopsy in 78%.
  • In tuberculous effusions, closed pleural biopsy was positive in 88%, open pleural biopsy in 100% and Mycobacterial culture in 23%.
  • In empyema, bacterial culture was positive in 39%.
  • Lung perfusion scans were done in 148 cases and were of no use in diagnosis.
• The authors' conclusion: The authors concluded that tests on pleural fluid are very useful in diagnosing the cause of pleural effusion. They also said the conditions of thoracentesis should be standardised and that open pleural biopsies should be taken in chronic effusions of undetermined cause.
• Limitations the authors state:
  • Many patients came from a department of internal medicine. The authors said this explains the many chronic effusions, the few due to heart failure or cirrhosis, and the differences in causes from other studies.
  • Only two species of anaerobic bacteria were identified in empyema cases, although anaerobes are a major cause of empyema. The authors noted that collection and processing methods have improved since the study began.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Bronchogenic Carcinoma, Mesothelioma, Pleural Biopsy, Empyema.

Related studies

• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
• Utility of hyaluronic acid in pleural fluid for differential diagnosis of pleural effusions: likelihood ratios for malignant mesothelioma — S. Atagi, M. Ogawara, et al. (1997)
• Expression Profiles of Cytokine mRNAs in the Pleural Fluid Reveal Differences Among Tuberculosis, Malignancies, and Pneumonia-Exudative Pleural Effusions — D.L. Espósito, V.R. Bollela, et al. (2015)
• Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions — Y. Yin, R. Eberhardt, et al. (2016)
• Scoring CT/HRCT findings among asbestos-exposed workers: effects of patient's age, body mass index and common laboratory test results — T. Vehmas, L. Kivisaari, et al. (2005)
• Use of antisera to epithelial membrane antigen for the cytodiagnosis of malignancy in serous effusions — A. To, D.V. Coleman, et al. (1981)

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