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Abstract

CONTRIBUTION OF PLEURAL BIOPSY IN THE DIAGNOSIS OF LYMPHOCYTIC EXUDATIVE PLEURISY

Rasoafaranirina Marie Odette*, Ravahatra Kiady, Rakotoarisoa Oninalafenitra, Martin Fidy Arnauld, Nandimbiniaina Anjaramihaja, Rakotondrabe Iantsotiana Davidson, Tiaray Harison Michel, Rakotomizao Jocelyn Robert, Rakotoson Joelson Lovaniaina, Raharimanana Rondro Nirina

ABSTRACT

Introduction: Blind pleural biopsy is a technique for investigating non-purulent pleurisy commonly used in developing countries such as Madagascar. The aim of the study was to evaluate the contribution of the pleural biopsy puncture in the etiological diagnosis of exudative lymphocytic pleurisy. Methods: Prospective study, involving 50 cases of multiple biopsies realized in the pneumology department Tambohobe Fianarantsoa University Hospital over a period of 12 months from January 2018 to December 2018. Pleural biopsy concerned subjects over 25 years of age who had exudative pleurisy (Protein level above 30g / l) predominantly lymphocyte (lymphocyte level greater than 50%). The biopsy forceps used was of the Abrams type. Results: The mean age was 53.48 years. The male sex is dominant in 74% of cases with sex ratio 2.8. Smoking was found in 48% of cases and chronic alcoholism in 24% of cases. Clinically, dyspnea was found in 88%; chest pain 22%, cough in 58% and fever in 52% of cases. The pleurisy was unilateral in 90% of the cases, of average abundance in 64% of the cases and great abundance in 36% of the cases. For the macroscopic appearance of the pleural fluid, 82% were citrins, 4% hematic and 14% haemorrhagic. The histological nature was dominated by granuloma caseous necrosis in 68% of cases, pleural metastasis in 12% and non specific inflammation in 20%. Conclusion: The contribution of pleural biopsy blindly is not negligible and can be proposed in first intention in the presence of exudative lymphocytic pleurisy. The repetition of the gestures is necessary when the first pleural biopsy puncture is not contributive, so as not to treat the patient wrongly as pleural tuberculosis even if we are in an endemic zone.

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