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Transudative Pleural Effusions

2000; Elsevier BV; Volume: 118; Issue: 3 Linguagem: Inglês

10.1378/chest.118.3.885

1931-3543

Yuri Moltyaner, M Miletin, Ronald F. Grossman,

Congenital Diaphragmatic Hernia Studies

We wish to draw the attention of readers to are trospective study, performed at our institution, of malignant pleuraleffusions in medical and surgical inpatients. The presence of a pleuraleffusion and of malignant cells on cytopathologic examination of apleural fluid sample obtained from the subject by thoracentesis wasrequired for study inclusion. Each case also had to have sufficientdata to allow application of the classic criteria of Light etal1Light RW McGregor MI Luchsinger PC et al.Pleural effusion: the diagnostic separation of transudates and exudates.Ann Intern Med. 1972; 77: 507-513Crossref PubMed Scopus (1205) Google Scholar for determining whether the pleural fluid sample sentfor cytopathologic examination was transudative or exudative. Thepresence of coexisting congestive heart failure, liver cirrhosis, ornephrotic syndrome was determined by reviewing the clinical impressionsof the treating physicians as well as all relevant laboratory and imaging studies. We identified 88 patients in a 7-year period from 1991through 1997. We found that 8% of the malignant pleural effusions in these subjectswere transudates. The average age of these patients was 70.4 years, and 47 of them were women. The primary malignancies experienced by thesubjects included the following: breast (two), prostate, colon, lymphoma, small cell lung cancer, and an adenocarcinoma of unknownprimary. All patients underwent two-dimensional echocardiography at thetime of the initial investigation of their pleural effusions. Fourpatients were found to have ejection fractions > 60%. Although threepatients were found to have an ejection fraction < 40%, only one ofthese patients had clinical and /or radiographic evidence of congestiveheart failure at the time of thoracentesis. No patient had evidence ofliver cirrhosis or nephrotic syndrome. Investigators have previously demonstrated that up to 20% ofpleural effusions occurring in subgroups of patients with activemalignant disease are transudates.2Vives M Porcel JM Vincente de Vera M et al.A study of Light's criteria and possible modifications for distinguishing exudative from transudative pleural effusion.Chest. 1996; 109: 1503-1507Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar3Romero S Candela A Martin C et al.Evaluation of different criteria for the separation of pleural transudates and exudates.Chest. 1993; 104: 339-404Abstract Full Text Full Text PDF Scopus (115) Google Scholar However, it isunknown what proportion of these patients had positive pleural fluidcytology. In a study that used Light's criteria to classify malignantpleural effusions, Assi and coworkers4Assi Z Caruso JL Herndon J et al.Cytologically proved malignant pleural effusions: distribution of transudates and exudates.Chest. 1998; 113: 1302-1304Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar found that only 1% were transudates. Contrary to the conclusions of these authors, we feelthat this low rate may provide clinicians false reassurance whenevaluating patients with transudative pleural effusions. Our findingslead us to suggest that clinicians should include cytopathologicexamination of the pleural fluids in the diagnostic workup of all newpleural effusions.