Tuberculous pleural effusions.

While a number of recent reports have documented the changing clinical and radiographic spectrum of parenchymal tuberculosis, relatively little attention has been paid to changes in the patterns of pleural tuberculosis. We therefore reviewed the clinical, laboratory, and radiographic characteristics of 26 adult patients with tuberculous pleural effusions. We found that pleural tuberculosis has become a disease of older adults (median age, 56 years) and that 19 percent (5/26) of the cases were due to postprimary (reactivation) disease. This shift in age led to problems in diagnosis, since many of these older patients had underlying or coexisting disease that could have caused a pleural effusion. Both specimens of pleural fluid and pleural biopsy were useful in establishing the diagnosis. Examination of sputum was less helpful. All patients who were not anergic had positive cutaneous reactions to first-strength purified protein derivative of tuberculin. Lymphocytosis of the pleural fluid was not a uniform finding; only 62 percent of our patients had greater than 50 percent lymphocytes on their initial examinations of pleural fluid, and four patients had greater than 90 percent polymorphonuclear cells. All of the effusions were exudates, and four had glucose levels in the pleural fluid that were less than 30 mg/dl. Pleural tuberculosis is an important diagnostic consideration in adult or elderly patients with exudative pleural effusions.

[1]  J. Sibley A study of 200 cases of tuberculous pleurisy with effusion. , 1950, American review of tuberculosis.

[2]  W. Stead,et al.  The clinical spectrum of primary tuberculosis in adults. Confusion with reinfection in the pathogenesis of chronic tuberculosis. , 1968, Annals of internal medicine.

[3]  J. Brody,et al.  Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult. , 1977, The American journal of medicine.

[4]  R. Macgregor,et al.  Tuberculosis: frequency of unusual radiographic findings. , 1978, AJR. American journal of roentgenology.

[5]  M. Nebut,et al.  Pleural effusion: laboratory tests in 300 cases. , 1979, Thorax.

[6]  S. K. Park,et al.  Unusual radiographic findings in adult pulmonary tuberculosis. , 1980, AJR. American journal of roentgenology.

[7]  C. Putman,et al.  Adult-onset pulmonary tuberculosis. , 1983, Radiology.

[8]  T. Williams,et al.  Update: the radiographic features of pulmonary tuberculosis. , 1986, AJR. American journal of roentgenology.