الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Pleural effusion is frequently a difficult clinical problem and its etiological diagnosis is very important to reach a proper management . A varitay of diseases may be associated with pleural effusion and several techniques are employed to determine the diagnosis .
This work was performed to study different etiology of exduative pleural effusion in Assuit university ,chest department during period September 2015 to September 2016 , fifty patients with pleural effusion were included in our study , 28 were males , 22 were female .
Complete history was taken ,clinical examination was done, chest X ray was done ,chest sonar was done for all patients . Pleural fluid was examined in all patients physically ,bacteriological and cytopathological .
Percutanecous pleural biopsy using Cope᾿s needle was performed in our study . PCR was done suspected tuberculous(lymphocytisc ) pleural effusion. Thoracoscopy was performed in undiagnosed pleural effusion .
Among 50 patients pleural effusion included in our study , 18 cases finally proved malignancy ( 36 % ), then post pneumonic effusion 17 cases ( 34%) and 15 cases were proved tuberculous pleural effusion ( 30 % ).
In 18 patients with malignant pleural effusion , the most presenting symptom was dyspnea in 16 cases ( 88.9% ) , chest X ray was massive in 16 cases ( 88.9% ), Chest ultrasound was homogenous echogenic in 10 cases ( 55.6% ) , pleural fluid was haemorrhagic in 11cases ( 61.1%), pleural fluid cytology was proved malignancy in 8 cases ( 44,4 %), so sensitivity of pleural fuild cytology was ( 44.4 %) , specificity of it 100% , positive predictive value and negative predictive value was 100% and 76.1% respectively. pleural needle biopsy was proved malignancy in 14 cases ( 77.8%) so sensitivity and specificity of pleural needle biopsy was 77.8% and 100% respectively and positive predictive value and negative predictive value was 100% and 88.9% respectively . thoracoscopy was diagnosed 4 cases ( 22.2 %) of malignant pleural effusion.
In 15 patients with tuberculous pleural effusion , the most presenting symptom was pleuritic chest pain in 15 cases (100 %) ,chest X ray was moderate in 9 cases ( 60 % ) , as regard chest ultrasound complex sepated in 10 cases ( 66.7% ).
Pleural fluid cytology was predominately lymptocytes in tuberculous pleural effusion .
Pleural needle biopsy was diagnosed tuberculous pleural effusion in 15 cases ( 66.7 %) .so ,The pleural needle biopy sensitivity and specificity in diagnosis of tuberculous pleural effusion was 66.7% and 100% respectively . Moreover ,the positive predictive value and negative predictive value was 100% and 87.5% respectively .
PCR of pleural effusion was proved in 14 cases ( 93.3 % ) . sensitivity and specificity about 93.3% and 100% respectively , the positive predictive value and negative predictive value was 100% and 97.2% respectively in our study .
Thoracoscopy used in suspected malignant effusion not diagnosed by other procedures , there was 4 cases (22.2%) diagnosed malignant effusion by thoracoscopy.