INTRODUCTION: Normal pleural space between visceral and parietal pleura is lined by thin film of fluid, but excess fluid accumulation in pleural space under certain pathological condition is termed pleural effusion. 1 Pleural effusions is common occurrence in both medical and surgical patients. The prevalence of pleural effusion is estimated to be slightly in excess of 400/100000 population. 2 Pleural effusion is an indicator of an underlying disease process that may be pulmonary or non-pulmonary in origin and may be acute or chronic. The most common types of fluid in pleural effusion include transudates and exudates, though there can be blood or pus also in pleural effusion. However, mechanisms leading to pleural effusion are different. (Box 1) These may differ in different etiologies, and include: increased hydrostatic pulmonary pressure in heart failure, increased capillary permeability in pneumonia, decreased oncotic pressure in hypoalbuminemia, decreased intrapleural pressure in atelectasis, obstructed lymph flow and increased pleural membrane permeability in pleural malignancy/infection, and diaphragmatic defects in hepatic hydrothorax. Rupture of thoracic duct is involved in chylothorax. 3 DIAGNOSIS OF PLEURAL EFFUSION: Patients with pleural effusions should be studied systematically. Detailed history taking and physical examination can help to establish direction towards diagnosis even before any other investigations. Based on history and examination, with signs/symptoms indicating a suspected pleural effusion, the initial step in evaluation of such patients is to confirm the diagnosis with radioimaging techniques (Chest X ray, ultrasound, computed tomography (CT) scan, etc). Next, the distinction between transudative and exudative pleural effusions would give an idea about the nature of fluid and narrow down the diagnosis. However, in many cases, a definitive diagnosis may require thoracentesis which allows withdrawing the pleural fluid sample and undertaking its physical, chemical, and microbiological studies. 4
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous, multisystem disease with complexities that extend far beyond airway obstruction. OBJECTIVES: The purpose of this prospective study is to determine pulmonary arterial hypertension in chronic obstructive pulmonary disease non-invasively. METHODS: In this descriptive, prospective, observational, cross sectional study, all patients who presented to the department of Medicine and Respiratory medicine, during this study period of 12 months from January 2013-December 2014 in Chennai were included. RESULTS: Total number of males in the study is 90(90%), females in the study is 10 (10%). Number of patients in the age group 25-35years was 06 (6%), 36-45years was 38(38%), 46-55 years was 30(30), number of patients in 56-65 years was 14 (14) and number of patients in the age group 66-75 years was 12(12). total number of males smoking in the study is 55(61.11%) and total number of non-smokers were 35(38.88), total number of female smoking in the study is 1(10%) and total number of nonsmokers were 9(90%). Pulmonary arterial systolic pressure in present study, Mild pulmonary arterial hypertension was seen in 26(26%), Moderate pulmonary arterial hypertension was seen in 54(54%), Severe pulmonary arterial hypertension was seen in 20(20%). CONCLUSION: This study shows the prevalence of pulmonary arterial hypertension in COPD patients.
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