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Clinical Investigations: INFECTION |

Resolution of Residual Pleural Disease According to Time Course in Tuberculous Pleurisy During and After the Termination of Antituberculosis Medication*

Dae-Hee Han, MD; Jae-Woo Song, MD; Hee-Soon Chung, MD; Jae-Ho Lee, MD
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*From the Departments of Radiology (Dr. Han) and Respiratory and Critical Care Medicine (Dr, Chung), Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul; Department of Radiology (Dr. Song), Seoul Asan Medical Center, Seoul; and Division of Respiratory and Critical Care Medicine (Dr. Lee), Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Correspondence to: Jae-Ho Lee, MD, Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, 300, Gumi-dong, Bundang-Gu, Seongnam Si, Gyeonggi-do, 463–707, Seoul National University Bundang Hospital, Republic of Korea; e-mail: jhlee7@snubh.org



Chest. 2005;128(5):3240-3245. doi:10.1378/chest.128.5.3240
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Study objectives: To assess the resolution of pleural disease in patients with tuberculous pleurisy (TP) during and after antituberculosis medication.

Design: An observational, prospective, longitudinal study.

Setting: University-affiliated general hospital in Seoul, Korea.

Patients and methods: Chest radiographs of 85 adult TP patients were followed up prospectively from diagnosis to 24 months after the start of medication. The extent of pleural disease, synonymous with the radiographic term, pleural opacity (PO), was evaluated at regular intervals according to a size scale. Additionally, following completion of 6 months of therapy, residual PO (RPO) was determined by either measurement of the widest width of the opacity, if loculated, or at the superior level of the hemidiaphragm.

Results: Seventy-seven patients had a PO graded ≥ 2 at the initial presentation. At 6, 9, and 24 months, the number of patients with these grades declined. At these time periods, there were 14, 8, and 7 patients, respectively, remaining with this classification. RPO > 10 mm at 24 months was considered indicative of significant residual pleural disease. During the period after 6 months of antituberculosis medication, the number of patients with RPO ≥ 10 mm declined from 43 patients at 6 months to 21 patients at 24 months. The presence of loculation on an initial chest decubitus view was associated with significant RPO at 24 months (p = 0.009).

Conclusion: In TP patients, improvement of RPO often occurred even after completion of 6 months of antituberculosis medication up to 24 months. A loculated PO at initial presentation, but not initial PO size, was a predictor of significant RPO at 24 months.

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