Syed Ali Abbas, Mohsin Bajwa, Zafar Ahmed.
Etiologies of Unilateral Pleural Effusion and Complications of Intercostal Drains.
Pak J Chest Med Jan ;23(1):08-14.

Background: Pleural effusion is a common medical problem faced by internists in general and chest specialists in particular. It occurs due to abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both. It is the most common manifestation of pleural disease. The etiological spectrum of pleural effusion may vary based on geographical location of the patient. In the Western world where people live longer, effusion is mostly seen due to non-infectious causes including malignancies and heart failure. Whereas, in developing countries, infectious causes predominate. Objective: To study the etiologies of unilateral pleural effusion and complications of intercostals drain. Methodology: This was a prospective study conducted at Liaquat National Hospital Karachi, Pakistan, during June 2015 to Dec 2106. All (48) adult patients (age above 16 years) admitted to chest ward from various sources with unilateral pleural effusion were included. Case notes were reviewed and data collected. Diagnostic pleural tap was performed in every case and aspirate was sent for biochemical, microbiological and cytological analysis. Pleural biopsies were taken where diagnosis could not be established with the help of other investigations. Duration of hospital stay, details of intercostal drain insertion and any related complications were recorded. Results: 48 patients with unilateral pleural effusion were identified. There were 28 (58%) men and 20 (42%) women. Majority 30 (42%) were in the age range between 40-69 years with mean age of 48 years. (Table 1). 31 (64%) patients needed to stay in hospital for more than a seven days. 30 (62%) had one and 18 (37%) had 2 or more attempts of thoracocentesis. 35 (73%) underwent contrast CT chest and 11 (31%) were found to have a pulmonary lesion and 4 (11%) had pleural lesion. 7 (15%) were referred to thoracic surgeons for surgical intervention. 5 underwent VATS and 2 had thoracotomies. Average waiting period between referral and surgery was 14 days. 11 effusions were transudate, 37 exudate, 4 had positive cytology. Microbiology was not positive in any case. 4 pleural biopsies were taken via Abraham's needle and remaining during surgery. Pleural TB, malignancy, left ventricular failure, chronic liver disease and parapneumonic effusions were the common causes of unilateral pleural effusion. Intercostals drain falling out or dislodging 8 (22%) and subcutaneous emphysema 4(11%) were the most common complications of intercostals drain insertion. Conclusion: Tuberculous pleural effusion and malignancy were the two common causes of unilateral pleural effusion. Majority of the patients needed to stay in hospital for more than a week if they had pleural effusion. Commonly observed complications of intercostals drain may be avoided by observing proper tube insertion and securing techniques.

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