Ebru Çakir EDİS, Ülker YILMAM, Tuncay ÇAĞLAR, Gündeniz ALTIAY

TRAKYA ÜNÜVERSİTESİ TIP FAKÜLTESİ GÖĞÜS HASTALIKLARI SERVİSİ'NDE 15 YILLIK SÜREÇTE YATIRILARAK İZLENEN PLEVRAL EFÜZYONLU HASTALARIN DEĞERLENDİRİLMESİ

Plevral efüzyon gö ğüs hastalıkları pratiklerinde sık karşılaşılan problemlerden biridir. Bu çalışmada kliniğimizde yatırılarak izlenilen plevral efüzyonlu hastalarda etyoloji ve tanı yöntemlerini incelemeyi planladık. Trakya Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Kliniği'nde 1992-2007 tarihleri arasında plevral efüzyon tetkik nedeniyle yatırılarak izlenilen 558 hasta retrospektif olarak incelendi. Hastaların 227'si (%40.6) malignite, 168'i (%30.1) tüberküloz plörezi, 89'u (%15.9) parapnömonik efüzyon, 14'ü (%2.5) konjestif kalp yetmezliği olarak değerlendirildi. Kırk beş hastaya ise (%8.1) tanı konulamamıştı. Plevral efüzyonlu hastaların 137'sine (%24.6) plevra biyopsisi, 98'ine (%17.6) bronkoskopi, 8'ine (%1.4) video torokoskopi ile tanı konulmuştu. On dört (%2.5) hasta önerilen invaziv girişimi kabul etmemişti. Malignite olarak izlenilen 227 hastanın 188'ine (%82.8) invaziv girişimler ile tanı konuldu. On dokuzuna (%8.4) uygulanan invaziv işlemler ile tanı konulamamıştır, yirmi (%8.8) hastaya ise invaziv işlem uygulanamamış olup değerlendirilmeleri klinik ve radyolojik olarak yapılmıştı. Kliniğimizde takip edilen plevral efüzyonlu hastaların yaklaşık %70'i malignite ve tüberküloz tanısı almıştı. Bu nedenle özellikle üçüncü basamak sağlık kurumlarında ileri yaşta efüzyonlu hastalarda ön planda malignite, genç yaş grubunda ise öncelikle tüberküloz plörezi düşünülmesi gerektiğini bir kez daha vurgulamak istedik.

Anahtar Kelimeler:

Plevral efüzyon, etiyoloji, tanı, malignite, tüberküloz

EVALUATION OF PLEURAL EFFUSION PATIENTS HOSPITALIZED IN THE CHEST DEPARTMENT OF TRAKYA UNIVERSITY MEDICAL FACULTY IN 15 YEARS PERIOD

Pleural effusion is one of the common problems seen in chest diseases practice. In this study, we planned to investigate the etiology and diagnostic methods in pleural effusion patients who were hospitalized in our clinic. 558 patients who were admitted to hospital due to pleural effusion in the Chest Clinic of Trakya University Medical Hospital in 1992-2007 were investigated retrospectively. Outpatients who were admitted to hospital in this period were excluded. Malignant pleural effusion was diagnosed in 227 (40.6%) patients, tuberculous pleurisy in 168 (30.1%), parapneumonic effusion in 89 (15.9%), and heart failure in 14 (2.5%). 45 (8.1%) patients remained undiagnosed. Of the patients with pleural effusion, 137 (%24.6) were diagnosed by pleural biopsy, 98 (%17.6) by bronchoscopy, 8 (%1.4) by video-assisted thoracoscopic surgery. 14 patients did not accept the invasive methods suggested. Of 227 patients with malignant pleural effusion, 188 (82.8) were diagnosed by invasive methods. 19 (8.4%) of them could not be diagnosed by the invasive methods applied. Invasive methods could not be performed in 20 (8,8%) patients and, therefore, their evaluations were made by clinical and radiological methods. Malignant pleural effusion and tuberculosis were diagnosed in approximately 70% of the patients who had pleural effusion and were followed in our clinic. We want to emphasize malignant diseases for the old patients with pleural effusion and tuberculous pleurisy for the young age group should be considered primarily.

Keywords:

Pleural effusion, etiology, diagnosis, malignant disease, tuberculosis,

PDF

___

1. Dev D, Basran GS. Pleural effusion: a clinical review. Monaldi Arch Chest Dis 1994; 49: 25-35.
2. Rosenbluth DB. Pleural effusions: Nonmalignant and malignant. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser LR, Senior RM (Eds.). Fishman’s Manual of Pulmonary Diseases and Disorders. 3th ed. New York: Mc Graw Hill Co; 2002: p. 487-506.
3. Light RW. Pleural Diseases. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2001.
4. Hansell DM, Armstrong P, Lynch DA, McAdams HP. Imaging of the disease of the chest. 4th ed. Philadelphia: Elsevier Mosby; 2005: p. 1023-92.
5. Light RW. The Undiagnosed Pleural Effusion. Clin Chest Med 2006; 27: 309-19.
6. Marel M, Stastny B, Melinova L, Svandova E, Light RW. Diagnosis of pleural effusions. Experience with clinical studies, 1986 to 1990. Chest 1995; 107:1598-603.
7. Batungwanayo J, Taelman H, Allen S, Bogaerts J, Kagame A, Van de Perre P. Pleural effusion, tuberculosis and HIV-1 infection in Kigali, Rwanda. AIDS 1993; 7: 73-9.
8. Ngoh HL. Pleural effusion in 100 Malaysian patients. Med J Malaysia 1991;46: 301-8.
9. Broaddus VC, Light RW. General principles and diagnostic approach. In: Murray JF, Nadel JA (Eds). Textbook of Respiratory Medicine. 3th ed. Philadelphia: WB Saunders Company; 2000: p 2008-9.
10. Johnston WW. The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer 1985; 56: 905-9.
11. Gürbüz B, Metintafl S, Metintafl M, Uçgun I, Alatafl F, Erginel S, Bektafl Y, Çelik H, Harmanc› E. Epidemiological features of bronchial carcinoma cases with environmental asbestos exposure. Tuberk Toraks. 2004; 52: 5-13.
12. Chhieng DC, Ko EC, Yee HT, Shultz JJ, Dorvault CC, Eltoum LA. Malignant pleural effusions due to small-cell lung carcinoma: a cytologic and immunocytochemical study. Diagn Cytopathol. 2001; 25: 356-60.
13. Senyi¤it A, Babayi¤it C, Gökirmak M, Topçu F, Asan E, Coflkunsel M, Ifl›k R, Ertem M. Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey. Respiration. 2000; 67: 610-4.
14. Light RW. Diagnostic principles in pleural disease. EurRespir J 1997; 10: 476-81.
15. Escudero Bueno C, Garcia Clemente M, Cuesta Castro B, Molinos Martin L, Rodriguez Ramos S, Gonzalez Panizo A, Martinez GlezRio J. Cytologicand bacteriologic analysis of fluid and pleural biopsy specimens with cope's needle. Arch. Intern Med 1990; 150: 1190-4.
16. Valdes L, Alvarez D, Valle JM, A Pose A, San Jose E. The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest 1996; 109: 158-62.