DOI: 10.36347/sjams.2019.v07i03.010

Pages: 901-905

The standard investigations to elucidate the etiology of pleural effusions are most often rewarding, but sometimes they do not yield the exact etiologic cause of effusion, particularly in tuberculous pleural effusion. The most important aspect of evaluating an exudative pleural effusion is differentiation between tubercular and non tubercular effusion as management strategy is different in each of these cases. Tuberculous pleural effusion (TPE) is the second most common form of extra pulmonary tuberculosis next only to lymph node involvement. Accurate diagnosis of pleural effusion is challenging because even after thoracentesis and/or closed pleural biopsy, 25-30% of pleural effusion remain undiagnosed. The proportion of TPE among total pleural effusions diagnosed by medical thoracoscopy is 23.5%. Alkaline phosphatase is a cell membrane derived enzyme and one of the biochemical markers found in pleural effusion. A prospective analytical study was conducted among 50 patients admitted in Department of Pulmonary Medicine, government chest diseases and tuberculosis hospital, and kakatiya medical college. Detailed history, general physical and systemic examination was done in all cases. Routine and specific investigations like chest Xray/CT scan, USG chest, Pleural fluid analysis, pleural fluid ALP, Serum ALP were done. Out of the total 50 cases 35 (70%) were diagnosed with Tuberculous pleural effusion. ROC curve analysis of Pleural fluid to serum ALP ratio showed a significance level of <0.001 with an area under curve of 87.2%. A sensitivity of 83.3% and specificity of 87.5% was seen at a cut off value of 0.49.ROC curve analysis of Pleural fluid ALP showed a significance level of <0.001 with an area under curve of 87.1%. A sensitivity of 83.7% and a specificity of 69.2% were seen at a cutoff value of 75.8 U/L.