Rom J Morphol Embryol 2012, 53(4):989–995 ISSN (print) 1220–0522 ISSN (on-line) 2066–8279 ORIGINAL PAPER The role of cytology in the diagnosis of fluid collection syndromes associated with liver cirrhosis. Clinical, epidemiological, cytological and biochemical study of pleural effusion MIHAELA DINU 1) , ANA CLAUDIA GEORGESCU 2) , RALUCA NICULINA CIUREA 3) , MIRELA ŞTEFAN 4) 1) PhD student 2) Department of Internal Medicine 3) Department of Pathology University of Medicine and Pharmacy of Craiova 4) Department of Pathology, Emergency County Hospital, Craiova Abstract Cirrhosis, end-stage of many liver diseases, presents many complications during its evolution. One of these is the presence of pleural fluid collection syndrome. This may be a direct consequence of liver disease (hepatic hydrothorax) or may be a random association. A formidable complication due to its consequences is spontaneous pleural empyema. The present study aimed to assess the incidence, the factors that influence its occurrence, and the frequency of the infectious complication. Keywords: cirrhosis, pleural effusion, spontaneous pleural empyema.  Introduction Hepatic hydrothorax is a transudate-type fluid accumulation in patients with advanced cirrhosis. The term was introduced by Morrow CS et al. (1958) in order to differentiate pleural fluid secondary to cirrhosis from other cases leading to fluid accumulation syndrome in patients with cirrhosis [1–2]. Incidence is assessed differently from one author to another. McKay DG et al. (1947) appreciates it as 1% of cases, Albin RJ and Johnston GS (1989) as 6%, Lieberman FL et al. (1966) as 5.4%, Cardenas A et al. (2004) as 5 to 10%, while Chen TA et al. (2003) as in 15% of all cases [3–7]. Pleural effusions are a common pneumologic diagnosis problem, often interdisciplinary, because of many benign or malignant diseases which can cause. In this respect, it is necessary to assess the type of cells in pleural aspirate which can be useful for diagnosis. The current study aimed to highlight the role of pleural fluid cytology correlation with clinical and laboratory data in patients with cirrhosis associated with pleural effusion.  Materials and Methods Between 2004 and 2011, we studied a number of 849 patients diagnosed with liver cirrhosis. The batch of 849 patients consisted of 423 (49.82%) females and 426 (50.18%) males with the following distribution depending on the etiology: 253 patients with alcoholic cirrhosis, 137 patients with HBV cirrhosis, 105 patients with HCV cirrhosis, 110 patients with B+C viral hepatitis, 149 patients with viral infection and alcohol consumption, 34 cases with immune cirrhosis, 12 cases with primary biliary cirrhosis, and 49 cases with cryptogenic cirrhosis. The patients were divided into functional classes according to the Child–Pugh criteria [8]. The diagnostic criteria for hepatic hydrothorax are [1, 2, 9]: ▪ PMN <250/mm 3 ; ▪ proteins <2.5 g/dL; ▪ effusion proteins/serum proteins <0.5; ▪ pleural fluid LDH/serum LDH >0.6; ▪ pleural fluid albumin/serum albumin >1.1; ▪ pleural fluid bilirubin/serum bilirubin <0.6; ▪ pH >7.4; ▪ pleural fluid glucose = serum glucose. Clinical examination was performed in all patients, and thoracentesis was performed in patients with pleural effusion with biochemical and cytological examination of pleural fluid. Pleural fluid extracted by thoracentesis was centrifuged for 10 minutes and the supernatant was spread on the slide, fixed with methanol and stained with May–Grünwald–Giemsa solution (Merck). In addition, for pleurisy cases suspected as having tuberculous etiology smears were fixed with methanol and stained using the Ziehl–Neelsen technique (Merck). R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/