The 119 patients had a total of 177 closed pleural biopsies performed. All except two of the patients had a diagnostic thoracocentesis prior to the biopsy and the pleural fluid was exudative by standard criteria (pleural fluid to serum ratio for protein >0.5 and/or LDH ratio >0.6) in all but one of these patients. Forty-one of the 119 patients were ultimately diagnosed as having malignant effusions, while the diagnosis of granulomatous pleuritis was confirmed in 25 individuals. The diagnosis of malignant or granulomatous pleural disease was established in 63 (95 percent) of these 66 patients while they were in the hospital. Two patients with nonspecific pleuritis were clinically suspected of having a tuberculous effusion, but the diagnosis was not confirmed until six weeks after discharge when the pleural biopsy cultures grew Mycobacterium tuberculosis. One patient with malignancy was discharged after three nondiagnostic pleural biopsies; ten months later, a transbronchial biopsy established the diagnosis of metastatic adenocarcinoma.
The remaining patients were ultimately classified as having nonspecific pleuritis. The etiology of the effusions in these 53 individuals is presented in Table 1. A single patient with lymphoma had nonspecific pleuritis on biopsy and nondiagnostic pleural fluid cytologic findings. He died of sepsis two months later, and unfortunately, permission for the autopsy was not granted. Although it is likely that the effusion was due to lymphoma, he is included in the idiopathic group since a malignant cause for the effusion could not be documented. None of the other patients with nonspecific pleuritis had evidence of either granulomatous infection or intrapleural malignancy during a follow-up period of 33 (±3) months.
Congestive heart failure was the most frequently identified reason for the pleural effusion in patients with nonspecific pleuritis. Heart failure was clinically diagnosed in 13 individuals during their hospital stay, whereas it first became clinically overt after discharge in nine other patients. It may well be that the pleural effusion was unrelated to the development of heart failure in these latter individuals, and that their disease was idiopathic. In over one third of the patients, no potential cause for the effusion was ever apparent, and these were classified as idiopathic effusions.
Table 1—Etiology of Effusion in Patients with Nonspecific Pleuritis
|IdiopathicCongestive heart failure||19 (1)*|
|Diagnosed during hospitalization||13 (5)|
|Systemic lupus erythematosis||1|
Category: Nonspecific Pleuritis
Tags: malignant granulomatous, nonspecific pleuritis, pleural disease