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What Causes Pleural Effusion?

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Posted on Mon, 23 Nov 2015
Question: Ihave fluid inmy left lung...afer sputum test it doesn't show any tb symptoms...after taking ada it showed 85% iu/l...afrer seeig these results doctor suspected tb is he correct?
doctor
Answered by Dr. Kaushal Bhavsar (34 minutes later)
Brief Answer:
Yes, you are having tubercular pleural effusion.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
ADA is adenosine deaminase. It is an enzyme secreted by lymphocytes.
So raised ADA in fluid is suggestive of lymphocytes rich fluid.
And tubercular pleural effusion is the most common cause for lymphocyte rich fluid.
So possibility of tubercular pleural effusion is more in your case.
It is tuberculosis of pleura (covering of lungs).
Hope I have solved your query.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (7 hours later)
My doctor siggested cinex 600,combutol,prizym 750...iam using those medicine for 15days still i did get chamge in my cough n sputum....even i didn't get hungry much...may i know d reason
doctor
Answered by Dr. Kaushal Bhavsar (5 minutes later)
Brief Answer:
Have you undergone pleural fluid aspiration?

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
Treatment of tuberculosis should lasts for atleast 6-8 months.
So improvement expecting in 15 days is too much early.
Usually improvement starts after 1 month of treatment.
In pleural effusion, therapeutic pleural fluid aspiration is important in symptomatic relief.
So please let me know if you had therapeutic aspiration or not. I am not talking about diagnostic aspiration which is only 10-20 ml.
Please reply me this, so that I can guide you better.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (26 minutes later)
Yes i have pleural fluid in my left lung n in ny ada test it showed 85% iu/l
doctor
Answered by Dr. Kaushal Bhavsar (3 minutes later)
Brief Answer:
You are not getting my question.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern but you are not getting what I am asking you.
I know you had pleural effusion and your ADA is 85.
In pleural effusion, symptoms are mostly due to fluid in the pleural cavity. This fluid causes compression and collapse of under lung. And this causes cough, expectoration, breathlessness etc.
So whenever there is excess of fluid, we should first remove as much fluid as we can. This is called as therapeutic aspiration.
Some doctors prefer only diagnostic aspiration. In this only 10-15 ml fluid which is needed for laboratory investigations is aspirated. So in this, patient is not getting more symptomatic relief because fluid is still there in the cavity.
So please let me know
1. How much amount of fluid is aspirated from your pleural cavity?
2. What is your weight? Tb drugs should be taken according to weight. Sometimes under dosage can also cause persistent symptoms.
So please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (35 minutes later)
Yes...they have taken 20ml for for lab purpose only....my weight is now 64....drugs r cinex 600,pyzina 750,combutol,happi-D,GUDCEF...
doctor
Answered by Dr. Kaushal Bhavsar (11 minutes later)
Brief Answer:
You need to increase the dose.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
Since you are having weight more than 60 kg, you need following doses.
1. RCinex (600/300) - 1 tablet in the morning.
2. Pyzina (750) - Two tablets in the morning
3. Combutol (400)- Two tablets in the morning.
Ideal dosage of Anti tb drugs for you is as above.
Please let me know
1. How much tablets of pyzina (750)you are taking?
2. What is the dose of your combutol tablet?
3. Do you take all these drugs at a same time?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (6 minutes later)
Iam taking cinex 600- 1tablet,pyzina 750-2tablets,combutol-1.5(one n half)tablets
doctor
Answered by Dr. Kaushal Bhavsar (3 minutes later)
Brief Answer:
What is the dose in mgs for combutol?

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
You are taking 1.5 tablets of combutol.
But please let me know the dose in mgs which combutol containing like 400,600,800mgs.
Also let me know whether you are taking all these drugs simultaneously or at different times of day like 1 in morning, 2 in afternoon and 1 in evening.
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (20 minutes later)
Combutol 800mg....all are taking at morning time only...still i didnt get hungry...
doctor
Answered by Dr. Kaushal Bhavsar (14 minutes later)
Brief Answer:
You might need therapeutic aspiration.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
You are taking correct drugs in the correct way.
But sometimes when pleural effusion is moderate to large in amount, therapeutic pleural effusion should be done.
Anti tubercular drugs should also be started but when quantity of fluid is more in pleural cavity, only anti tubercular drugs will need longer time for improvement. In such cases therapeutic aspiration (take out as much as you can) gives excellent improvement in symptoms.
So please let me know
1. What is the amount of fluid in your pleural cavity? This must be mentioned in ultrasound or chest x ray report.
2. Do you have breathlessness?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (31 hours later)
11*6.5cm...my main problem is even using medicine iam getting cough ..cant get hungry
doctor
Answered by Dr. Kaushal Bhavsar (46 minutes later)
Brief Answer:
You should first complete 1 month of treatment.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.. In my opinion, you should first complete 1 month of treatment.
And then get done chest x ray after 1 month.
If it shows that the quantity of fluid is same or increasing then you need therapeutic aspiration.
But if quantity is decreasing then no need to worry, complete the six months of treatment.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (21 minutes later)
i have only one doubt...i didn't get tb symptoms in cultural n sensitivity test...but i got in ada 80% iu/l n protien total-pleural fluid 6.0%..in pleural fluid wbc count is 150 cells/ul,differentail count is neutrophils -70%g/dl n lymphocytes -30%

pls tell me by observing above results... is der any chance to get lung cancer?
doctor
Answered by Dr. Kaushal Bhavsar (16 hours later)
Brief Answer:
You need to get done pleural fluid cytology.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
AFB positivity is very low in tubercular pleural effusion. But high protein, high ADA are markers of tubercular pleural effusion.
So your diagnosis is appropriate.
Honestly speaking malignant pleural effusion also show high protein and high ADA. But it is mostly hemorrhagic (reddish) in color. So for confirmation you need to get done pleural fluid cytology.
So please let me know
1. What was the appearance of fluid? Was it yellowish or reddish?
2. Pleural fluid cytology done or not?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kaushal Bhavsar (19 minutes later)
it appearered as sightly turbid n colour is yellow...cytology not done
doctor
Answered by Dr. Kaushal Bhavsar (51 minutes later)
Brief Answer:
Are you smoker?

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
Possibility of tubercular pleural effusion is more in your case.
But if you are smoker and positive family history of lung cancer then turbidity in fluid can be seen in malignant pleural effusion.
So please let me know.
1. Are you smoker?
2. Do you have significant weight loss?
3. Do you have positive family history of lung cancer?
4. Do you have prolonged chemical exposure?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
Answered by
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Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 15004 Questions

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What Causes Pleural Effusion?

Brief Answer: Yes, you are having tubercular pleural effusion. Detailed Answer: Thanks for your question on Health Care Magic. I can understand your concern. ADA is adenosine deaminase. It is an enzyme secreted by lymphocytes. So raised ADA in fluid is suggestive of lymphocytes rich fluid. And tubercular pleural effusion is the most common cause for lymphocyte rich fluid. So possibility of tubercular pleural effusion is more in your case. It is tuberculosis of pleura (covering of lungs). Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.