Our review consisted of two parts. The medical records of all patients who underwent thoracentesis at the University of Massachusetts Medical Center between July 1, 1986 and June 30, 1987 were analyzed according to the criteria for retrospective chart review established by Feinstein et al. Patients were divided into three groups based upon the presence, absence or lack of information concerning symptoms of cough, dyspnea, and chest pain. Constitutional and other non-chest symptoms were not used in determining asymptomatic status. The SPE group consisted of patients reporting cough, dyspnea and/or chest pain. The APE group consisted of patients who specifically denied these symptoms. A third group included patients in whom absence of symptoms was not specifically mentioned in the chart. Only the first thoracentesis performed on any patient during the study period was included. Procedures were reviewed to determine the frequency of transudates and exudates, radiographic characteristics and most likely- diagnosis of each effusion. Chest radiographs were reviewed by one of the investigators. The size of the effusion was estimated on the initial upright inspiratory posteroanterior chest film. A large effusion filled greater than 50 percent of the hemithorax, medium filled 25 to 50 percent, and a small effusion less than 25 percent. An effusion was determined to be free-flowing by reviewing lateral decubitus chest films.
The clinical diagnosis made during the patients hospitalization was used unless there was definite objective evidence to contradict it. If such information existed, an alternative diagnosis was assigned. We attempted to make a diagnosis based upon available information in the remainder. An effusion was considered indeterminate when the information required to distinguish it as exudate or transudate and assign a diagnosis was lacking.
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We then reviewed the English literature on pleural effusion during the years 1975 to 1988 using BRS Colleague computer- assisted search program. Index terms were “pleural effusion”.