Paramalignant effusions are pleural effusions found in patients with solid tumors without direct pleural involvement and no evidence of malignant cells in pleural fluid. There is limited published data describing complete pleural fluid analysis (PFA) of paramalignant effusion and its causes. The purpose of our study was to define the PFA and report the clinical and radiographic findings of these effusions.
We reviewed our pleural fluid database from 2001–2008 and identified 150 consecutive cases of paramalignant effusions.
Among our 975 pleural fluid database patients, 143 (15%) had malignant effusions while 150 (16%) had paramalignant effusions. Mean age of the patients with paramalignant effusion was 63.2 (26–93) years. 78 (52%) patients were male. There were 57 (38%) right sided, 34 (23%) left sided and 59 (39%) bilateral pleural effusions. Paramalignant effusions were most commonly associated with lung cancer (41%) followed by breast cancer (13%). Other associated malignancies were: esophageal, gastric, pancreatic, colorectal, ovarian, renal cell carcinoma and lymphoma. The cause of paramalignant effusion could be established in 88 (59%) of 150 patients.
Pleural fluid characteristics of paramalignant effusion ranged from transudates to concordant exudates. The most common cause of paramalignant effusion was lymphatic obstruction from mediastinal lymphadenopathy.
Paramalignant effusions comprise half of malignancy associated pleural effusions. They are commonly found in patients with lung cancer. The pleural fluid characteristics vary depending on underlying cause.
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