Tuberculous pleural thickening

Case contributed by Dr Dalia Ibrahim

Presentation

Chest pain and dyspnea.

Patient Data

Age: 18 years
Gender: Female

Left sided circumferential nodular pleural thickening involving the costal, mediastinal, and diaphragmatic pleura as well as the pleural fissures.

Enlarged paratracheal, prevascular, aorto-pulmonary, subcarinal, left hilar lymph nodes.

Pathology

Tru-cut biopsy showed tuberculoid granulomatous reaction.

Case Discussion

This is a rare presentation of pleural TB. The nodular pleural thickening was highly suggestive of the neoplastic process (metastasis, lymphoma or mesothelioma), yet the young age of the patient and the absence of asbestos exposure or primary tumor were against those possibilities.

Tru-cut needle biopsy of the pleura revealed tuberculoid granulomatous reaction and excluded malignancy.

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.

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