Pleural Effusion: Diagnostic Approach in Resource-limited Settings
N. S. Rohith Raja, A. Arthi, V. Jereen, D. L. Sam Bennihin, Moniish VenkatesanAbstract
Background:
Pleural effusion is a common occurrence in many different types of health care facilities and has a broad spectrum of potential causes, from benign systemic disorders to potentially fatal infections and tumors. In developing countries and resource-poor environments where sophisticated imaging techniques, specialty laboratory tests, and trained personnel are not always available, timely and accurate diagnosis presents major obstacles. As a result, clinicians utilize both clinical judgment and basic testing to guide the diagnosis of pleural effusion using pragmatic, cost-effective methods.
Objective:
To review and synthesize available evidence on the diagnostic approach to pleural effusion, with a focus on strategies applicable in resource-constrained healthcare environments.
Methodology:
The electronic database literature was reviewed through a narrative process. Literature was reviewed from electronic databases (e.g., PubMed, Scopus, and Google Scholar) through the use of keywords: pleural effusion, diagnosis in resource-limited settings, thoracentesis, etc., All articles that met the inclusion criteria (i.e., published articles in English that identify diagnostic methods and challenges faced when diagnosing patients with a pleural effusion in a low-resource setting) and that were published as guidelines, original research articles, and review articles were included in the review. Articles that were not related to diagnostic methods or simply dealt with elaborate methods of imaging were removed from the database before analysis.
Results:
Clinical assessment, chest X-ray, and diagnostic thoracentesis are key to diagnosing pleural effusions in settings with limited resources. While Light’s criteria remain commonly used to help differentiate between transudative and exudative effusions, their use will be limited by laboratory constraints. Where feasible, point-of-care ultrasound represents an incredibly helpful adjunct to these procedures. Tuberculosis and parapneumonic effusions are the most common causes of pleural effusion in low-resource locations, thus requiring a high degree of clinical suspicion. Simplified diagnostic algorithms that combine clinical presentation with findings from simple investigations can help direct management choices.
Conclusion:
To maximize the benefit of a systematic diagnostic evaluation of pleural effusion in resource-poor environments, an organized approach combining patient history taking (clinical assessment) with a limited range of readily available laboratory tests will yield the greatest results. Investing time in developing cost-effective resources for key diagnostic procedures, establishing standardized clinical pathways for diagnosing pleural effusion, and providing the appropriate level of education/training for physicians to use these resources effectively will enhance both the diagnostic accuracy of the clinician and the overall survival rates of patients diagnosed with pleural effusion in the low-resource setting.