Annals of Tropical Medicine and Public Health
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Year : 2012  |  Volume : 5  |  Issue : 3  |  Page : 168-172

A clinicopathological study of tuberculous pleural effusion in a tertiary care hospital

1 Department of Pathology, Jalpaiguri Sadar Hospital, Jalpaiguri District, India
2 Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
3 Department of Community Medicine, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India

Correspondence Address:
Indranil Chakrabarti
Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal - 734 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.98606

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Context: Tuberculosis is a major contributor of exudative pleural effusion which is the second most common extra-pulmonary manifestation of tuberculosis following tubercular lymphadenitis. Aims: To re-evaluate the time tested and easily available investigation of closed pleural biopsy and its relation with pleural fluid adenosine deaminase (ADA) level and cytological findings in the clinically suspected cases of tuberculous pleural effusion. Materials and Methods: A total of 44 cases of suspected tubercular pleural effusion were selected from the indoor ward of a tertiary care hospital, over a period of 13 months. Apart from the relevant history taking and clinical examination, thorough investigations were done in each case to prove the etiological diagnosis, which comprised of routine hemogram, bleeding time, clotting time, Mantoux test, sputum microscopy, enzyme-linked immunosorbent assay (ELISA) for HIV, chest X-ray, examination of pleural fluid including ADA estimation, culture for Mycobacterium tuberculosis (BACTEC), and finally, pleural biopsy by Abram's needle. Results: A total of 65.8% cases of tuberculous pleural effusion were diagnosed by pleural biopsy results. Second biopsy attempts improved the diagnostic ability by 18.4%. The highest incidence was observed in the 11-20 years age group (36.8%). Chest pain (86.8%) was the predominant symptom. Positive Tuberculin skin test was observed in 89.5% cases. Pleural fluid analysis showed a predominance of lymphocytes in all the cases, with 97.3% patients having ADA levels > 70 U/L. There was no major complication of pleural biopsy. Conclusions: Pleural biopsy is a very important tool for diagnosing tuberculous pleural effusion without any major complication. ADA values > 70 U/L are highly suggestive of tubercular etiology and correlated well with histopathological findings of pleural biopsy.

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