Objectives: To determine the frequency of tuberculosis and malignancy in transudative pleural effusions.Material and Method: The study was conducted in Pulmonology-OPD, Gulab Devi Teaching Hospital Lahore from Oct. 2017 to Feb. 2019. One hundred and twenty-eight consecutive patients with transudative pleural effusions and 14-69 years age, willing for invasive investigations & ADA estimation were included, while those not willing for further investigations, participation in the study, and exudative effusions were excluded. The clinical features, pleural fluid analysis findings, ADA(Adenosine deaminase) estimation results, hematology, echocardiography, bronchoscopy, Lymph node biopsy, CT-thorax, ultrasound chest & abdomen results were recorded on a preformed proforma. Findings were summarized, tabulated, and analyzed statistically using SPSS-16 software.Results: Out of 1370 cases of pleural effusion, 128 cases (9.34%) with pleural transudate were isolated. In all patients, pleural fluid protein/serum protein level was < 0.5. The age ranged 14-69 years with a mean of 39 years + 11.3. Fifty-two cases (40.62%) had right-sided, 38 cases (29.68%) left-sided while 38 cases (29.68%) had bilateral pleural effusions. Seventy-six aspirates (59.37%) were yellow, 20 (15.62%) reddish, 18 (14.06%) straw-colored and 14 fluids (10.93%) were watery in color. Out of 128 transudative effusions, malignant etiology was found in 23 cases (17.96%), tubercular in 17 cases (13.28%) and 19 cases (14.84%) of Para-pneumonic origin were detected.Conclusion: Tuberculosis and malignancy can be the possible etiology of transudative effusion.

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

Pulmonary Hamartomas are benign lung tumors, containing cartilage, connective tissue, fat and usually appear as peripheral lesions. They are 2-4 cm in size, frequently asymptomatic, comprising of 5–8% of all solitary pulmonary nodules. The peak incidence occurs in 40-70 years of age with a male preponderance. We describe a unique case of centrally located, giant chondroid hamartoma, in the background of pulmonary hemosiderosis. Patient presented with cough, shortness of breath and left sided chest pain, masquerading as pleural effusion, lung cancer and left sided chest pain mimicking myocardial disease. Chest x-ray raised the suspicion of pleural effusion but ultrasound and CT-scan indicated a benign calcified central mass. A presumptive diagnosis of cartilage-containing benign mass was made on ultrasound-guided percutaneous biopsy, while surgical resection followed by histopathology revealed a chondroid hamartoma. No recurrence was noted on follow-up. Chondroid hamartoma can be large, symptomatic and requires modern modalities for diagnosis while its association with pulmonary hemosiderosis, still requires to be investigated.

Background: Corona virus infection requires early detection and precise diagnosis for an effective control in community. COVID-19 PCR is the gold standard diagnostic test having low sensitivity and adequate availability constraints. Because of high false negative rate, a large number of undetected patients remain a constant source of inadvertent disease dissemination in the community. This study was conducted to explore the diagnostic usefulness of transthoracic ultrasonography for COVID-19 pneumonia during the current pandemic. Material and Methods: This cross-sectional study was conducted in the Pulmonology OPD of Gulab Devi Teaching Hospital, Lahore-Pakistan from April 1, 2020 to July 30, 2020. A total of 237 patients with dry cough, fever and shortness of breath of sudden onset, clinically diagnosed as COVID-19 pulmonary infection, were included in the study. Patients were investigated with chest x-ray/HRCT, transthoracic ultrasonography, COVID-19 RT-PCR on nasopharyngeal samples and hematological tests. Sensitivity, Specificity, PPV (positive predictive value), NPV (negative predictive value) and diagnostic accuracy of transthoracic ultrasonography was calculated with P-value <0.05 considered as statistically significant. SPSS-26 software was used for statistical analysis. Results: Of the total 237 patients (mean age 41.23±17.5 years) presenting with complaints of a pulmonary infection, 228 were diagnosed as COVID-19 pulmonary infection by transthoracic ultrasonography and PCR.  Bilateral lesions and B-lines were the most frequent characteristic features on ultrasonography (n=237 patients; 100%). Transthoracic ultrasound diagnosed 228 patients as cases of COVID-19 pneumonia with 100% sensitivity, 66.67% specificity, 98.7% PPV, 100% NPV, and 98.73% diagnostic accuracy. Only 135 /228 (59.21%) patients were diagnosed by RT-PCR. The P-value by Fisher exact test was highly significant at 0.001 (cut-off P- value < 0.05). Conclusion: Transthoracic ultrasonography is a useful diagnostic tool with a high sensitivity, is free- from radiation exposure and capable of providing foundations for evidence based, early detection of corona virus pneumonia in a pandemic situation.