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REVIEWOFLITERATURE
n the approach in the diagnosis of pleural effusion the first step is todetermine whether the effusion is a transudate or exudates (Light
et al 
1995 & Sahn 1988). An extensive diagnosis work–up is needed in cases withexudative effusion to determine the aetiology [Light et aI 1972]. Till the timeof Paddok [1940] who used the P
H
, specific gravity and pleural fluid proteinto divide the exudates from transudates. It becomes the standard parameter todivide the pleural fluid as exudates and transudates by a pleural fluid proteinconcentration of greater than and less than 3.0 gm/dl respectively till 1972.Light and coworkers [1972] demonstrated that misclassifications of 10% caseswere made using the parameter of pleural fluid protein of3.0 gl/dl alone.
I
 Anatomy of Pleura:
The pleura is the serous membrane that covers the lung parenchyma, the mediastinum, diaphragm and the rib cages. This is dividedinto visceral and parietal pleura. The visceral pleura covers the points of contact with wall, diaphragm mediastinum and the interlobar tissues. The parietal pleura line the inside of the thoracic cavity. In accordance with theintrathoracic surfaces it is divided into the costal, mediastinal anddiaphragmatic pleura the visceral and parietal pleura meet at the lung root. Atthe pulmonary hilus the mediastinal pleura is swept laterally onto the root of the lung. Posterior to the lung root the pleura are carried downward as a thindouble fold called
the pulmonary ligament 
[Light
et al,
1995].A film of fluid is normally present between the parietal and thevisceral pleura. This thin layer of fluid acts as a lubricant and allows thevisceral pleura covering the lung to slide along the parietal pleura lining thethoracic cavity during respiratory movements. A potential space present between two layers of pleura is designated the pleural space. The mediastinumseparates the right from the left pleural space in humans.
 
 Development of Pleura and Pleural Space:
The body cavity in the embryo, the coelomic cavity is a U– shaped system with the thick bend cephalad. The cephalad portion becomes pericardium and communicates bilaterally with the pleural canals, which inturn communicates with peritoneal canals. As the embryo develops, thecoelomic cavity becomes divided into the pericardium, the pleural cavitiesand the peritoneal cavities through the development of the sets of partition – (1)
The septum transversum which serves as an early, partial diaphragm.
(2)
 Pleuropericardial membrane which divides the pericardial and pleural cavities and 
(3)
 Pleuroperitoneal membranes which unites with the septum transversumto complete the partition between each pleura and peritoneal cavities.This newly formed pleural cavity fully lined by a mesothelial membranes, the pleura.
When the primordial bronchial buds first appear they and thetrachea lie in a median mass of mesenchyme, cranial and dorsal to the peritoneal cavity. The mass of the mesenchymal tissue is the futuremediastinum and separates the two pleura cavities. As the growing primordiallung buds bulge into the right and left pleural cavity. They carry with them acovering of the living mesothelium, which becomes the visceral pleura. As theseparate lobes evolve they retain the mesothelial covering.This becomes the visceral pleura and the living mesothelium of the pleural cavity becomes the parietal pleura [Light
et al 
1995].
 Nerve Supply of Pleura:
The parietal pleura are supplied by the somatic nerves. These are:(1)
 Inter costal nerves, supply the costal pleura and parietal pleura and  peripheral part of the diaphragmatic pleura.
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(2)
 Phrenic nerve supplies the mediastinal and central portion of thediaphragmatic pleura. These somatic nerves are pain sensitive and innervates the part of the pleura supplies by inter costal nerve isreferred to the adjacent chest wall and the pleura supplied by the phrenic nerve referred to ipsilateral shoulder.
The visceral pleura are supplied by autonomic nerves, so it isnot pain sensitive [Singh 1993].
 Blood Supply of Pleura:
The parietal pleura receives its blood supply from the systemiccapillaries. Small branches of the inter costal arteries supply the costal pleurawhereas mediastinal pleura is supplied principally by the pericardiophrenicartery. The diaphragmatic pleura are supplied by the superior phrenic andmusculophrenic arteries. The veins drain mostly into the azygos and internalthoracic veins. The visceral pleura are supplied mainly by the branches of the bronchial artery which divides into a network of much dilated capillaries[Hayek 1960; Harris
et al 
1977].
 Lymphatic Drainage:
The lymphatic vessels of the costal pleura drain ventrally toward thenodes along the internal thoracic artery and dorsally toward the internal inter costal lymph nodes near the heads of the ribs. The lymphatics of the mediastinal pleura pass to the tracheobronchial and mediastinal nodes, where as the lymphaticsof the diaphragmatic pleura pass to the parasternal, middle phrenic and posterior mediastinal nodes [Bernauddin
et al 
1980]. The lymphatics of the visceral pleuradrain sub–pleurally into interlober vessels then to hilar nodes [Burke
et al 
1966].
 Microanatomy of the Pleura:
The microstructure of the pleura consists of a single layer of mesothelial cells, without basement membranes. A layer of compressed
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