Monday, January 24, 2011

Tuberculous pleural disease

Here's a nice review from Current Opinion in Pulmonary Medicine.

A few key points and pearls:

...a complex septated pattern on sonography in lymphocyte-rich exudative pleural effusions was 96% specific and had a positive predictive value (PPV) of 94% for a tubercular cause.
A study by Kim et al. [23] of 106 patients with tuberculous pleuritis revealed that lung parenchymal lesions were detected in 91 cases (i.e. 86%) using chest CT scan...
Usually 90–95% of the pleural fluid cells are T-lymphocytes, the remainder being B-lymphocytes...
Eosinophilia more than 10% and mesothelial cells more than 5% in the pleural fluid are also traditionally felt to make TB an unlikely diagnosis...

Adenosine deaminase levels in the pleural fluid play a major role in diagnosis. Adenosine deaminase was not discussed in this review, as there was another article in the same issue devoted to that, which I will post separately.

Pleural biopsy and thoracoscopy were discussed.

What about nucleic acid amplification tests? Currently available test has been approved by the FDA for diagnostic testing of pleural fluid. There is considerable experience with the tests, however. They can be useful because they have high specificity. They are not recommended for ruling out tuberculous pleural disease, however, because of low sensititivity.

Scoring systems combining clinical and pleural fluid data have shown promise.

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