الفهرس 
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Abstract
This study was performed to assess different etiologies of pleural effusion especially idiopathic pleural effusion. This study were included89 patients among those who attended Chest Department ., Assiut University Hospitals from October 2017 to October 2020 All patients were subjected to medical history and examination, chest X-ray, Multislice CT chest, transthoracic ultrasonography, pleural fluid analysis and cytology, serum level of carcinoembryonic antigen and immunoglobulin G4. Pleural biopsy, bronchoscopy and thoracoscopy when indicated Mean age of enrolled patients in this study was 53.23 ± 14.98 years. Out of enrolled patients; 52 (58.4%) patients were males and 41 (46.1%) patients were females. 48 (53.9%) patients came from urban areas and also, majority (85.4%) was married A total of 17 (19.1%) patients were none smokers and 20 (22.5%) patients were passive smokers. Thirty (33.7%) patients were smokers and 22 (47.7%) patients were ex-smokers. Only two patients were opioid addict The most frequent presentations were chest pain (97.8%), cough (85.4%) and dyspnea (79.8%). Fever, expectoration, anorexia and hemoptysis presented in 56 (62.9%), 52 (58.4%), 47 (52.8%), 28 (31.5%) patients, respectively.Only five patients had bilateral effusion while 33 (37.1%) and 51 (57.3%) patients had right and left sided pleural effusion, respectively Consolidation was present in 28 (31.5%) patients while mediastinal lymphadenopathy was detected in 14 (15.7%). Only 19 (21.3%) patients had normal finding 0f the pleura while 49 (55.1%), 13 (14.6%) and 6 (6.7%) patients had thick, irregular and nodular pleura, respectively.Majority (67.4%) of patients had Serosanginous pleural fluid while 17 (19.1%) patients had serous fluid and the other 12 (13.5%) patients had hemorrhagic fluid. Sixteen (18%) patients had positive adenosine deaminase in pleural fluid.Pleural biopsy was done in 75 (84.2%) patients. Based on histopathogical evaluation of pleural biopsy, chronic non-specific inflammation, metastatic adenocarcinoma, caseating tuberculous granuloma, malignant mesothelioma, and lymphoplasmacytic infiltration were detected in 40 (44.9%), 18 (20.2%), 10 (11.2%), 4 (4.5%), and 3 (3.4%) patients, respectively Only 3 (3.4%) patients were subjected to bronchoscopy and their histopathogical evaluation revealed metastatic adenocarcinoma (three patients), chronic non-specific inflammation (two patients), and normal findings (two patients) As regard thoracoscopy, it was done performed in 34 (38.2%) patients. Histopathological evaluation revealed lymphoplasmacytic infiltration in 17 (19.1%) patients, caseating tuberculous granuloma in 5 (5.6%) patients, malignant mesothelioma in 5 (5.6%), metastatic adenocarcinoma in 4 (4.5%) and finally, chronic non-specific inflammation in 3 (3.4%) patients.