Tuberculous pleural effusion

Case contributed by Dr Dalia Ibrahim

Presentation

Chest pain and dyspnea.

Patient Data

Age: 30 years
Gender: Male

Marked left pleural effusion with contralateral mediastinal shift, associated with collapse of the underlying lung lobes and mild non-uniform scattered sheets of pleural thickening.

Annotated image

Mild non-uniform scattered sheets of pleural thickening (Yellow arrows)

Pathology

Pleural biopsy revealed tuberculous granulomatous inflammatory reaction with minimal caseation.

Case Discussion

In the case of TB, pleural involvement may be in the form of pleural effusion usually in the early stages of the disease, empyema, or pleural thickening associated with calcifications and adhesions usually in chronic cases.

TB is usually the leading cause of pleural effusion in the developing countries. Tuberculous pleural fluid represents an exudate with predominant lymphocytes.

The gold standard for the diagnosis of tuberculous effusion is either:

  • the detection of Mycobacterium tuberculosis in pleural fluid,
  • or pleural biopsy specimens showing caseating granulomas in the pleura with acid-fast bacilli

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