The Morphological Features And Diagnostic Value Of Tuberculous Pleurisy Under Thoracoscopy

【Objective】Tuberculous pleurisy(TP) lacks of specific clinical manifestations, imaging changes,and its diagnostic value is less than that of lung diseases.Therefore,it is difficult to diagnose TP based on clinical information and imaging.In recent years,pleural biopsy,pleural effusion etiology examination and detection of biological and chemical target has become the primary means to diagnose TP.Pleural effusion etiology examination[including pleural fluid smear finding acid-fast bacilli smear(AFB) and cultivation of tubercle bacilli from hydrothorax] due to the low positive rate or time-consuming is too long,and its clinical application is limited.Thoracoscopy therefore get more and more attention.This study focused on overview the morphologyical features of tuberculous pleurisy with direct visualization under thoracoscope and evaluate the diagnostic value of thoracoscopy in tuberculous pleurisy.【Materials and methods】We performed a retrospective study of 125 patients with tuberculous pleurisy diagnosed by thoracoscopy under local anesthesia in our hospital between November 1987 and January 2007. The 125 patients with TP comprised 66 men and 59 women,with a mean(±SD) age of 47.2±16.5 years,ranged from 16 to 87 years.The mean course of patients is 32±4.3 days,ranged from 6 to 180 days. The effusion was on the right side in 59 patients,on the left side in 53 patients,on both sides in 10 patients,and on both sides and pericardium in 3 patients.16 patients with Substantial pleural effusion, 56 patients with medium volume,33 patients with small amounts,and 20 patients with encapsulated pleural effusion,all is exudative pleural effusion.There are 50 patients with bloody pleural effusion and 75 patients with pale yellow Clinical symptoms:20 patients with fever,50 patients with cough,90 patients with chest distress,46 patients with chest pain.【Result】Total of 108 patients(86.4%) was successfully diagnosed by thoracoscopy with pathological or bacteriological examination,2 of them with bacteriological examination positive.There are four types of the morphological features of tuberculous pleurisy under thoracoscope:Type 1 pleural congestive and edema(19 patients, 15.2%) with a mean course of 5.6±3.7 days,Type 2 diffused granules(42 patients,33.6%) with a mean course of 10.1±2.3 days, Type 3 one or more sarcoidosis(40 patients,32.0%) with a mean course of 15.6±2.4 days,and Type 4 pleural thickening and adhesions (24 patients,19.2%) with a mean course of 32.8±3.5 days.The pleural lesions are mainly distributed on costal pleura and diaphragmatic pleura.【Conclusion】 The morphological features of tuberculous pleurisy are variable, which may be related to the pathogenesis and course of the disease. In patients with suspected tuberculous pleurisy,thoracoscopic pleural biopsy should be actively performed,because the technique has a high diagnostic rate,and can be easily and safely performed.