HEMORRHAGIC PLEURAL EFFUSION; AN ANALYSIS OF 120 CASES

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Abstract
120 cases of hemorrhagic pleural effusion were analyzed to de- termine the relative frequency of the underlying diseases. 78 cases were due to malignant neoplasm. In 77 of these, the neoplasm was metastatic, with the primary neoplasm in the lung in half of the cases. In only one case was the tumor primary in the pleura. Tumor cells were found in 50% of the hemorrhagic pleural effusions examined, which was the same frequency as that observed in non-hemorrhagic neo-plastic effusions. Whenever a unilateral hemorrhagic: pleural effusion is suspected to be of neoplastic origin, it is appropriate to begin the diagnostic studies with an investigation of the lung. 42 cases were not due to malignant neoplasm, viz. miscellaneous inflammatory conditions (13 cases), tuberculosis (8 cases), pulmonary embolization (10 cases), pelvic fibromatous tumors (2 cases), leukemia (2 cases), Hodgkin''s lymphogranulomatosis (1 case), uremia associated with cardiac failure (1 case), undetd. causes (5 cases). Of the tuberculous hemorrhagic pleural effusions, 4 appeared as "idiopathic" pleural effusions; two as part of a tuberculous polyserositis, one in association with cirrhosis of the liver, and only one was associated with chronic pulmonary tuberculosis. The frequency of the various types of, polyserositis as a cause of hemorrhagic pleural effusion (4 cases) is noteworthy. The presence of a hemorrhagic effusion may be the sole evidence of a hidden pulmonary embolus. The detn. of the % of polymorphonuclears and lymphocytes in the fluid does not aid in differentiating between malignant and inflammatory conditions of the pleura. The two pases of hemorrhagic effusion due to lymphatic leukemia were characterized by lymphocytic counts much in excess of all other cases in this series. The finding of pure blood, not a serosanguinous fluid, in the pleural cavity limits the differential diagnosis to 2 conditions: spontaneous hemopneumothorax and neoplasm.

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