PURPOSE: Lung and pleural tuberculosis were a scourge of early humans, as shown by its discovery in the lung of Egyptian mummies. Pleural tuberculosis especially in older patients is very important since many of these patients have underlying or coexisting diseases like cancer, COPD, and congestive heart failure (CHF) that can produce pleural effusions and may impede diagnosis.
METHODS: During 15 years of period (1999- 2004) 100 patients with a diagnosis of tuberculous pleural effusions were hospitalized in thoracic ward of Tabriz University, Imam Khomeini Hospital. There were 64 male. 36 female. The criteria for tuberculous effusion were: 1.Caseating granuloma in pleural biopsy2.Positive smear for Acid Fast Bacilli (AFB) from pleural fluid3.Positive sputum culture for T.B.4.Culture of sputum positive for mycobacterium Tuberculosis with either an exudative pleural effusion or non-caseating granulomas in a pleural biopsy.
RESULTS: During 15 years we admitted 100 patients with tuberculous pleural effusion. (64 male, 36 female). The average age was 52 Years (range 6-90 years). The most frequent symptoms were fever and cough; also dyspnoea weight loss and chest pain were common. The common hystologic features were caseating (46%), and non-coseating (41%), granulomata that identified in pleural biopsy. Parenchymal involvement was seen after tapping in the majority of patients (69%). All the patients were treated with Anti-tuberculous agents. Gradual resolution of pleural effusion was seen in the majority of patients except 13 cases. Surgical decortication was done for 7 patients with persistent pleural thickening.
CONCLUSION: Tuberculous pleural effusion in adult and elderly patients is an important diagnostic problem. For this reason Physicians must pay attention to diagnosis. we suggest pleural biopsy and pleural fluid culture in any adult patients with undiagnosed pleural effusion to rule out the possibility of tuberculous pleurisy.
CLINICAL IMPLICATIONS: Pleural tuberculosis is an important diagnostic consideration especially in elderly patients, because many of these older patients have underlying or coexisting disease that could have caused pleural effusion.
DISCLOSURE: Abolfazl Shirinzadeh dastgiri, None.