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INTRODUCTION

leural effusion is a common complication of many disease processes

either local or systemic.PPleural 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

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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 serumeffusion albumin gradient in the

differential diagnosis of pleural effusion.

To compare serumeffusion albumin gradient to Lights traditional

criteria for disgnosing transudative or exudative pleural effusion.

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