Chest
Volume 100, Issue 5, November 1991, Pages 1264-1267
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Clinical Investigations
The Relationship between Pleural Fluid Findings and the Development of Pleural Thickening in Patients with Pleural Tuberculosis

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The objective of the study was to determine if residual pleural thickening after treatment for pleural tuberculosis could be predicted from the pleural fluid findings at the time of the initial thoracentesis. Forty-four patients initially diagnosed as having pleural tuberculosis between January 1986 and January 1988 were separated into two groups: the 23 patients in group 1 had residual pleural disease, while the 21 patients in group 2 had no residual pleural disease after treatment for their pleural tuberculosis was completed. The clinical characteristics of the two different groups did not differ significantly, but the patients in group 1 tended to be a little sicker in that the duration of their symptoms was longer, their hemoglobin values were lower, and weight loss and cough were more frequent. There were no significant differences in the pleural fluid findings in the two different groups. The mean pleural fluid protein level was 5.40 ± 0.58 g/dl for group 1 and 5.17 ± 0.80 g/dl for group 2, while the mean pleural fluid glucose level was 78.6 ± 19.5 mg/dl for group 1 and 79.5 ± 20.1 mg/dl for group 2. The mean pleural fluid lactate dehydrogenase (LDH) level in group 1 was 593 ± 498 IU/L, while the mean level for group 2 was 491 ± 198 IU/L. The presence of residual pleural thickening was not related to the chemotherapeutic regimen or the performance of a therapeutic thoracentesis. From this study we conclude that approximately 50 percent of patients with pleural tuberculosis will have residual pleural thickening when their therapy is completed, but that one cannot predict which patients will have residual pleural thickening from either their clinical characteristics or their pleural fluid findings.

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Materials and Methods

Between January 1986 and January 1988, 71 patients with pleural tuberculosis were seen at the Hospital das Clinicas of the Faculty of Medicine of the University of Sao Paulo (Brazil). All patients who had either a pleural biopsy specimen showing granulomas with caseous necrosis and/or pleural fluid or pleural tissue positive on culture for Mycobacterium tuberculosis were included in the study. Forty-four patients returned to follow-up after 6 to 12 months and these patients form the study

Results

The clinical characteristics of the 23 patients with and the 21 patients without residual pleural thickening were quite similar (Table 1). The mean ages and hemoglobin levels were nearly identical in the two groups. There was no significant difference in the fraction of patients with fever, weight loss, chest pain, night sweats, dyspnea, or cough in the two different groups, although the group that was left with residual thickening did have a slightly longer duration of symptoms and slightly

Discussion

The present study demonstrates that there is approximately a 50 percent incidence of residual pleural thickening when chemotherapy is completed for pleural tuberculosis. The incidence of residual thickening does not appear to be related to the initial biochemical findings in the pleural fluid or the clinical characteristics of the patients at the time of presentation. Moreover, the incidence of residual thickening was not related to the chemotherapeutic regimen or the performance of a

Acknowledgments

We thank the following physicians who took care of the patients in the Ambulatory Clinic of Tuberculosis of the Hospital das Clinicas-Faculty of Medicine-University of Sao Paulo: Eliane C. R. Follador, Fernanda M. V. Boueri, Loavo M. Leite, Teresa Y. Takagaki, and Ronaldo A. Kairalla. We thank Marian Berman for her assistance with the medical illustrations.

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Reprint requests: Dr. Light, Chief of Research (151), VA Medical Center, Long Reach 90822

Manuscript received December 20; revision accepted March 12.

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