Role of therapeutic thoracentesis in tuberculous pleural effusion

Abstract

CONTEXT:Prevalence of tuberculous pleural effusion is very high in the Asian subcontinent but very few studies have come up from this part of the world about the course of recovery of pulmonary functions after institution of anti-tubercular therapy (ATT) and thoracentesis.AIMS:To study initial lung function impairment, changes over time after institution of ATT and thoracentesis and residual abnormalities left at the end of six months of treatment.SETTINGS AND DESIGN:Randomized open level interventional study over two years in 52 patients at a tertiary level teaching hospital.METHODS:The study population was divided into two equal groups, A (therapeutic thoracentesis) and B (diagnostic thoracentesis). Spirometry, chest radiograph and ultrasonography of thorax were done initially and at each follow-up visit up to six months. Statistical analysis was done (P value < 0.05 considered significant).RESULTS:Both groups were comparable initially. After six months none in group A and five patients in group B had minimal pleural effusion. During follow up, mean percentage predicted of FEV1 and FVC increased more in A than in B and the differences were statistically significant (P < 0.05). Pleural thickening, initially absent in both groups, was found to be more in B as compared to A at subsequent follow-up visits and this was statistically significant (P < 0.05).CONCLUSIONS:Thoracentesis should be considered in addition to anti-TB treatment, especially in large effusions, in order to relieve dyspnea, avoid possibility of residual pleural thickening and risk of developing restrictive functional impairment.

Role of thoracentesis in the management of tuberculous pleural effusion

“…Also Krenke and Korczynski [22] And there was a significant difference (P-value 60.05) between both groups, after 2 and 6 months of treatment. Our results are in agreement with those of Bhayuna et al [29] who found that after 6 months of anti tuberculous treatment alone (group B) 5 cases remain with mild pleural effusion while no effusion was found in the other group (group A) who treated with anti tuberculous drugs beside therapeutic thoracocentesis and also they found that the incidence of pleural thickening was higher in group B and this limitation was confirmed radiologically and with repeated pulmonary functions. However many [30][31][32] studies concluded that the therapeutic thoracentesis had no beneficial effects over anti tuberculous alone on preventing pleural thickening and recommended therapeutic thoracentesis only for relieving dyspnea associated with tuberculous pleural effusions.…”

Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study

“…TBP could infect the pleura through various routes, causing exudation, hyperplasia, and necrotic inflammation which mainly consisted of lymphocyte and monocyte infiltration. Unlike TB, patients with tuberculous pleural effusion usually have an acute febrile illness with nonproductive cough and pleuritic chest pain, night sweats, chills, weakness, dyspnea, and weight loss can also occur (4,21). If it is not diagnosed and treated in time, TBP often leads to serious complications such as pleural thickening, calcification, empyema, bronchopleural fistula, etc.…”

Is there any role for thoracoscopy in the diagnosis of benign pleural effusions

“…The biggest benefit is gained when it is used in the group with multiloculated effusion (25.4%) and organized phase of tuberculotic lung entrapment (39.4%) . A lower incidence of residual pleural thickening, immediate relief from dyspnea and somewhat improved lung function parameters are noted in patients with tuberculous effusion who have undergone therapeutic thoracentesis via chest tube drainage …”