INTRODUCTIO

P leural effusion is a common complication of many disease processes

either local or systemic.

Pleural effusion refers to excess pleural fluid formation from the

parietal pleura or the interstitial spaces of lung or secondarily from peritoneal
cavity or when there is decrease fluid removal by the lymphatics. The first
step in the approach to a patient with pleural effusion is to determine whether
the effusion is transudative or exudative. A transudative effusion occurs when
systemic factors that influence the formation and absorption of fluid are
altered and an exudative effusion occurs when local factors influencing the
formation and absorption are altered.

The most common cause of transudative pleural effusion is

congestive heart failure (60 to 70%; Glazier J B et al), cirrhosis of liver and
ascites (5%; Lieberman F L et al 1966 & Lieberman 1970). In many parts of
the world the most common cause of an exudative pleural effusion is
tuberculosis. Malignant pleural effusion secondary to metastasis are second
most common (75% of all malignant pleural effusion are lung carcinoma,
breast carcinoma and lymphoma) (Richard W Light, 2001).

An extensive diagnostic work up is needed in cases with

exudative effusion to know the cause (Light et al 1972). For these various
parameters were evaluated but until recent time the Light criteria established
in 1972, was found to distinguish exudative plural effusion from transudative
pleural effusion.

However in the recent years several reports indicated that these

criteria misclassified a number of pleural effusions and for this several
parameters were assessed, nevertheless all these alternatives falsely classified
  INT RODU CTI ON  2

some effusions and their superiority with respect to light's criteria is therefore
insignificant. In 1990 Roth et al assessed the diagnostic value of serum –
pleural effusion albumin gradient with a cut off value of 1.2 gm/dl to
differentiate exudative and transudative pleural effusion and obtain the
specificity of 100% compared with 72% with Light's criteria.

Controversies exist as to the parameter or parameters applicable

to differentiate exudative and transudative pleural effusion and for this
various research work are going .on to find a accurate cheap parameter to
correctly classify the transudative and exudative effusion.

AIMS AND OBJECTIVES:

 To study the significance of serum–effusion albumin gradient in the

differential diagnosis of pleural effusion.

 To compare serum–effusion albumin gradient to Light’s traditional

criteria for disgnosing transudative or exudative pleural effusion.

usu