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Objective: Pleural effusion (PE) takes an important place in the clinical practice of thoracic diseases because of the difficulties in establishing an etiological diagnosis. The causes of effusion differ depending on the region where the examination is carried out, the clinic and the population involved. In this study, we aimed to evaluate adult patients who were examined due to PE in our clinic at a specific hospital for chest diseases. Methods:The recordings of 240 patients who were hospitalised between June 2010 and July 2013 in our clinic and examined due to PE were retrospectively evaluated. Their fluid samples were taken and the patients were exposed to advanced invasive procedures when necessary. Demographic features of the patients, fluid analyses, diagnostic methods and diagnoses were reviewed. Results:Of the cases, 68% were male. The mean age was 58±20 years and the most common complaint for admission was shortness of breath. The amount of pleural fluid was moderate in 56% of the cases. Eighty seven percent of the fluids were exudative. The concentration of glucose was below 60 mg/dL in 40 patients and the concentration of adenosine deaminase was above 40 U/L in 39 patients. The diagnosis of tuberculosis (TB) pleurisy was established to a great extent. Of the invasive procedures, closed pleural biopsy and fiberoptic bronchoscopy contributed to the diagnosis at rates of 47% and 21%, respectively. Of 61 malignancy-induced PEs, 38 were due to primary lung cancer and 8 were due to malignant mesothelioma. Apart from mesothelioma, 66% of these effusions were malignant effusions and contribution of the initial thoracentesis to this diagnosis was found to be 40%. Conclusion:In our serial study, the most common causes of PE was TB in female patients, and pneumonia in male patients. Invasive procedures except thoracentesis were performed for 160 cases in total in the study. In 10 cases, the etiology of effusion could not be identified.

Rheumatoid arthritis (RA), as a systemic autoimmune disease, frequently features pulmonary involvement. A 58-year-old woman was examined due to shortness of breath, stomach ache, and arthralgia. Pleural effusion and bilateral pulmonary nodules were observed on chest X-ray, and patient was sent to our hospital with initial diagnosis of metastatic lung cancer. Creactive protein level and sedimentation rate test results were elevated. Thoracentesis was performed, and pleural effusion was found to be exudative. Low glucose and high adenosine deaminase and lactate dehydrogenase levels were detected. Blood and pleural fluid rheumatoid factor levels measured because of the presence of arthralgia were found to be high. High blood anti-cyclic citrullinated peptide levels were also detected. After consultation with department of rheumatology, patient was diagnosed as RA with pulmonary involvement. Pleural effusion and nodules resolved after treatment with methylprednisolone. This case was presented to emphasize that RA should be kept in mind in differential diagnosis of bilateral pulmonary nodules and pleural effusion.

Pulmonary thromboembolism (PTE) is caused by thrombus originating from deep leg veins and obstructing the pulmonary artery and/or its branches. PTE is a preventable disease with high mortality and morbidity. It may relapse and is sometimes difficult to diagnose. The average annual incidence of venous thromboembolism (VTE) is 23-269/100.000 and it increases with age. The risk of VTE is 10 times higher after 80 years of age than at the age of 45-50 years (1-4).Emergency physicians and chest disease specialists often demand some tests more than necessary to exclude the diagnosis of PTE. Although D-dimer test is widely used, false positive rate is high. In addition, when the pulmonary computed tomography (CT) angiography is used more than necessary in the emergency department, it has high cost and many other risks such as radiation and contrast-induced acute kidney failure (5).Although pulmonary CT angiography is a very effective method in the diagnosis of thromboembolic lesions located in the main and lobar pulmonary artery branches, its sensitivity in Objective: Pulmonary thromboembolism (PTE) is caused by thrombus originating from deep leg veins and obstructing the pulmonary artery and/ or its branches. PTE is a preventable disease with high mortality and morbidity. It may relapse and is sometimes difficult to diagnose. Unnecessary diagnostic tests are applied to many patients with suspected PTE. The aim of this study was to investigate the frequency of PTE in patients presenting with a preliminary diagnosis of PTE to emergency clinic of a tertiary chest diseases hospital. Methods:The triage forms of all patients who were admitted to the emergency clinic of tertiary chest diseases hospital within one year were examined. Demographic characteristics, risk factors for PTE, examinations and definite diagnosis data were obtained from the automation system of our hospital and evaluated retrospectively. Results:In 2012, the number of patients admitted to the emergency department was 33,413 and 411 patients (0.12%) were examined with preliminary diagnosis of PTE. After initial evaluation, 292 patients (71%) were hospitalized, 117 patients (28.5%) were called for outpatient clinic follow-up, and two patients were referred to another hospital with non-PTE diagnosis (0.5%). After examinations at outpatient clinic or hospital admission, PTE was detected in 111 patients (27%) and deep vein thrombosis was found in 19 patients (4.6%). While 236 patients (57.4%) were diagnosed as non-PTE, 6 patients (1.5%) died before a definite diagnosis and 39 patients (9.5%) did not attend outpatient clinic examinations. PTE was detected in 16.2% (n=19) of the patients followed in outpatient clinic and in 31.5% (n=92) of the hospitalized patients. Conclusion:In conclusion, the frequency of suspected PTE was 0.12% in patients admitted to the emergency department and 27% of these patients were diagnosed with definite PTE.

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