Role of medical thoracoscopy in the treatment of tuberculous pleural effusion

Abstract

Background: Fibrous tuberculous pleural effusion (TPE) represents common disease in tuberculous clinic. Medical thoracoscopy has been used to treat pleural empyema and shown promising outcomes, but data of its use in multiloculated and organized TPE remains limited to know.

Methods: The study was performed on 430 cases with TPE. The cases were divided into free-flowing, multiloculated effusion and organized effusion group. Each group was subdivided into two or three types of therapeutic approaches: ultrasound guided pigtail catheter, large-bore tube chest drainage and medical thoracoscopy. Patients with multiloculated or organized effusions received streptokinase, introduced into the pleural cavity via chest tubes. The successful effectiveness of the study was defined as duration of chest drainage, time from treatment to discharge days and no further managements.

Results: Patients with organized effusion were older than those with free-flowing effusion and incidence of organized effusion combined with pulmonary tuberculosis (PTB) was higher than those of multiloculated effusion and free-flowing effusion respectively. Positive tuberculosis of pleural fluid culture was higher in organized effusion than that in free-flowing effusion. Sputum positive for acid-fast bacillus (AFB) in organized effusion was higher than that in multiloculated effusion and free-flowing effusion. Medical thoracoscopy showed significant efficacy in the group of multiloculated effusion and organized effusion but free-flowing effusion. No chronic morbidity and mortality related to complications was observed.

Conclusions: Medical thoracoscopy was a safe and successful method in treating multiloculated and organized TPE.

Keywords: Tuberculous pleural effusion (TPE); extra-pulmonary tuberculosis; medical thoracoscopy; pleurisy; tuberculosis (TB).

Figure 1

Ultrasonographic image of a free-flowing pleual effusion (A) and fluid without fibrin deposition as seen during a medical thoracoscopy (B); ultrasonographic image of septated effusion (C) presented as fibrinous strands and web-like appearance without fibrous thickening of the pleura (D); ultrasonographic image of multiloculated effusion (E) presented as intrapleural loculation and fibrous thickening of the pleura (F); the adhesions or the fibrinous strands between the lung and chest wall were carefully separated and removed with closed biopsy forcep under medical thoracoscopy (G); and the fibrin, the caseous necrosis, the fibrous thickening pleura and other organized components were removed with closed biopsy forcep as much as possible (H).

Figure 2

Enrolment of patients and completion of the study.

Figure 3

Age distribution of patients with TPE tended to be young. 21.8% was 21−30 years old, 20.6% was 31−40 years old and 20% was 41−50 years old. TPE, tuberculous pleural effusion.