BACKGROUND Evaluation of pleural effusion is a common medical problem and despite the use of standard pleural fluid measurements and pleural biopsy the aetiology remains uncertain in a considerable number of cases. In our study, we assessed the importance of ADA activity in the diagnosis of pleural effusion. MATERIALS AND METHODS We studied 100 cases of pleural effusions of varying aetiology. Analysis of pleural fluid biochemistry cytology, ADA levels, ZN stain and results of pleural biopsy were analysed. This was a descriptive study. Statistical Analysis-Data were summarised using descriptive statistics such as percentages for categorical variables and mean with standard deviation for quantitative variables. For inferential statistics, two sample t-test was applied. A 'p' value of < 0.05 was considered significant. Sensitivity, specificity, positive predictive value and negative predictive values were calculated for using ADA as a screening test of TB pleural effusion. RESULTS We found Tubercular and Parapneumonic effusions in a younger age group (20-50 yrs.), whereas malignant effusions and those due to cardiac failure were found in an older subset (50-80 yrs.). Pleural biopsy positivity rate was 60%-80% in tuberculosis and 50%-85% in malignant effusions. ZN smear for AFB gave poor yield in sputum and pleural fluid. In all our patients, pleural fluid ADA was above 41.5 U/L with a mean value of 73.92 U/L. CONCLUSION Pleural fluid ADA in tubercular pleural effusion has a sensitivity, specificity, positive predictive value and negative predictive value at a cutoff of 41.5 U/L of 100%, 87%, 90%, 100% respectively.

Lymphangioleiomyomatosis (LAM) is a rare, progressive systemic disease of unknown etiology, insidious onset, often fatal, and underdiagnosed. It is exclusively found among women. LAM mainly involves the lungs where, as its name suggests, lymphatic (lymph), blood vessel (angio), and airways are surrounded by smooth muscle (leiomyoma) proliferation. It may be associated with tuberous sclerosis with clinical manifestations varying from simple cough to the development of recurrent pneumothoraces, haemoptysis, and pleural effusions. There is currently no treatment or cure. We present a rare case of a 41-year-old female, who presented with recurrent pneumothoraces, whose high-resolution computed tomography findings that were suggestive of multiple bullous lung disease, and the thoracoscopic biopsy revealed features of LAM. She was offered video-assisted thoracoscopic surgery in form of bullectomy and pleurodesis to reduce the volume of abnormal tissue and treated with progesterone hormonal therapy. The present case aims to focus on clinical-radiologic and pathologic findings and the treatment modalities available in developing countries like India where lung transplantation is seldom performed.

We report the case of a 26-year-old male patient diagnosed with Takayasu arteritis after 4 years of first manifestation. He developed sensorineural hearing loss in left ear, followed 2 years later by acute onset paraparesis and hypertension, and followed another 2 years later by short duration of upper backache, chest pain, palpitations, and breathlessness. On examination, he had hypertension without any significant blood pressure (BP) difference within arms with all peripheral pulses palpable. Diagnosis confirmed with computerized tomography aortography showing multifocal wall thickenings in entire aorta. In our case, the first presentation was otological followed 2 years later by hypertension. Our report points toward fact that hypertension, though the most common, may not be the first manifestation and characteristic examination finding of BP difference, and pulselessness may not be seen in all cases. High risk of suspicion and early use of specific investigation in cases of multisystem involvement in young hypertension are crucial for timely diagnosis.