The Relationship between Pleural Fluid Findings and the Development of Pleural Thickening in Patients with Pleural Tuberculosis

Barbas, C S; Cukier, Alberto; Varvalho, Carlos R.R. de; Filho, João Valente Barbas; Light, Richard W.

doi:10.1378/chest.100.5.1264

Cited by 94 publications

(81 citation statements)

References 12 publications

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“…LEE et al [13] reported 10%, SOLER et al [14] reported 72% and DE PABLO et al [7] and BARBAS et al [8] reported intermediate values of 43% and 52%, respectively. These variations can be attributed to the lack of a uniform concept for RPT.…”

Section: Discussionmentioning

confidence: 99%

“…Delay in implementing proper therapy for these effusions is responsible for much of the morbidity, which can be substantial. This delay can lead to characteristic changes in the pleural space, including loculations and pleural thickening [6].Previous studies have assessed what features predict pleural thickening in tuberculous pleural effusions [7,8], however only one study has retrospectively analysed predictive factors for the development of residual pleural thickening (RPT) in parapneumonic pleural effusions (PPE) [9]. Moreover, there are no studies addressing if RPT is associated with long-term functional consequences in this group of patients.…”

mentioning

confidence: 99%

“…Previous studies have assessed what features predict pleural thickening in tuberculous pleural effusions [7,8], however only one study has retrospectively analysed predictive factors for the development of residual pleural thickening (RPT) in parapneumonic pleural effusions (PPE) [9]. Moreover, there are no studies addressing if RPT is associated with long-term functional consequences in this group of patients.…”

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Prognostic features of residual pleural thickening in parapneumonic pleural effusions

Castro¹,

Díaz²,

Pérez-Rodríguez³

et al. 2003

Eur Respir J

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The objective of the study was the identification of predictive factors for the development of residual pleural thickening (RPT) in patients with parapneumonic effusion.The design of the prospective study involved investigating patients with parapneumonic pleural effusions diagnosed between March 1991 and December 2000 in the respiratory department of Hospital Ramón y Cajal (Madrid, Spain) which is a 1,500 tertiary-care hospital.The clinical and radiological characteristics and measurements of microbiological and biochemical variables in the pleural fluid taken from the patients were studied. RPT was defined in a posteroanterior chest radiograph as pleural thickening of o10 mm measured at the lateral chest wall at the level of an imaginary line, tangent to the diaphragmatic dome.A total of 48 of the 348 patients studied (13.79%) were found to have RPT. Among the factors studied, only presence of pus in the pleural space, Fine classes IV and V, temperature o38uC and delayed resolution of pleural effusions after diagnosis (w15 days) were independently associated with the risk of RPT.This study showed that significant residual pleural thickening was not a common complication of parapneumonic pleural effusions. There are certain risk factors for the development of residual pleural thickening. However, this complication was not associated with long-term functional repercussions in the series of patients involved in this study. Despite the advent of potent antibiotics, bacterial pneumonia still results in morbidity and mortality. The annual incidence of bacterial pneumonia is estimated to range from 1.8-8 cases per 1,000, withy20% requiring hospitalisation [1]. It has been reported that 57% of hospitalised patients with bacterial pneumonia have an accompanying pleural effusion [2][3][4]. The morbidity and mortality rates in patients with pneumonia and pleural effusions are higher than in patients with pneumonia alone [5]. Most pleural effusions associated with pneumonia resolve without any specific therapy directed toward the pleural fluid [2], however y10% require operative intervention for their resolution. Delay in implementing proper therapy for these effusions is responsible for much of the morbidity, which can be substantial. This delay can lead to characteristic changes in the pleural space, including loculations and pleural thickening [6].Previous studies have assessed what features predict pleural thickening in tuberculous pleural effusions [7,8], however only one study has retrospectively analysed predictive factors for the development of residual pleural thickening (RPT) in parapneumonic pleural effusions (PPE) [9]. Moreover, there are no studies addressing if RPT is associated with long-term functional consequences in this group of patients.The purpose of the present study was to prospectively evaluate the prognostic features of RPT and its functional repercussions in a consecutive series of patients with PPE. The authors therefore hypothesise that RPT is an uncommon complication of PPE and is no...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Prognostic features of residual pleural thickening in parapneumonic pleural effusions

Castro¹,

Díaz²,

Pérez-Rodríguez³

et al. 2003

Eur Respir J

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“…However, this study showed only a weak correlation (r=-0.298) between the degree of pleural thickening and the reduction in FVC [69]. Patients with low pleural fluid glucose, a high pleural fluid LDH level, and high pleural cytokine levels are likely to have a higher incidence of pleural thickening [72,74]. In a randomized controlled study of 52 patients, the administration of 2.5 mL of a hyaluronate-based gel resulted in significantly faster fluid absorption and significantly less pleural thickening at 3 months (0.57 vs. 1.14 cm) [75].…”

Section: Treatment Chemotherapymentioning

confidence: 92%

“…Residual pleural thickening may occur in approximately 50% of patients 6-12 months after initiating therapy [72]. The pleural thickening may result in a reduction in vital capacity.…”

Section: Treatment Chemotherapymentioning

confidence: 99%

Tuberculous Pleural Effusion

Cohen

Light

2015

Tur Toraks Der

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When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult. KEY WORDS:Tuberculosis, pleural effusions, adenosine deaminase, gamma interferon, pleural biopsy, empyema INTRODUCTION Tuberculosis (TB) remains a major public health problem in developing countries. Most patients with TB have pulmonary TB; however, 25% of adults can present with extrapulmonary TB, which mainly involves the lymph nodes and pleura but can affect any organ system, including the central nervous system (CNS), cardiovascular system, and gastrointestinal (GI) tract [1]. The most common form of extrapulmonary TB is infection of the pleura. In a patient who presents with undiagnosed pleural effusion, the diagnosis of TB pleuritis should be considered. Pleural effusion, as an isolated manifestation of TB, may be selflimited and of little immediate concern, but untreated, it can lead to serious disease many years later. Pathogenesis and Pathologic FeaturesTuberculous pleural effusion may occur in the absence of radiologically apparent TB [2]. The effusion may result as a sequela to a primary infection from 6-12 weeks earlier, or it may represent the reactivation of TB [2]. In developed countries, TB pleural effusions present more often in older patients. The median age in one North American study was 56, suggesting reactivation of the disease [3]. However, a study from 2004 in San Francisco showed that pleural TB cases were 2 times more likely to be clustered (when assessed by genotyping of the mycobacterial organisms) than pulmonary TB and 3 times more likely to be clustered than nonrespiratory TB cases [4]. The observations made in the San Francisco study suggest that the majority of patients has a postprimary infection [4]. This was not confirmed in studies performed in both Houston [5] and Baltimore [6] or in a study in sub-Saharan Africa, in which the prevalence of pleural TB was 63.2% in patients with a primary TB infection [7].The pathogenesis of TB pleural effusion is thought to be related to the rupture of a subpleural caseous focus in the lung into the pleural space [8]. The basis for this was the observation that a caseous TB focus could be demonstrated in the lung, contiguous with the diseased pleural, in 12 to 15 patients with TB pleuritis [9]. The 3 other patients in this study had parenchymal disease but did not have caseous foci adjacent...

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