Morphological manifestation of tuberculous pleurisy in children under medical thoracoscope and diagnostic value

Abstract

Objective: Our study analyzed the main manifestations of tuberculous pleurisy (TBP) in children under medical thoracoscopy (MT). This article aimed to explore the clinical application value of MT in the diagnosis and treatment of TBP in children.

Methods: In our study, we selected 23 TBP patients diagnosed in our hospital. We analyzed the clinical data and thoracoscopic morphology of these patients. At the same time, we also observed the pathological manifestations, acid-fast staining, and treatment effects of the patient's diseased tissue under MT.

Results: The MT clinical findings of TBP patients include pleural hyperemia and edema, miliary nodules, scattered or more white nodules, simple pleural adhesion, wrapped pleural effusion, massive cellulose exudation, yellow-white caseous necrosis, pleural hyperplasia and hyperplasia, and mixed pleural necrosis. The positive rate of pleural biopsy was 73.91% and that of acid-fast staining was 34.78%. The main pathologic types of these patients were tuberculous granulomatous lesions (16 cases), caseous necrosis (5 cases), and fibrinous exudative, multinucleated giant cell and other inflammatory cell infiltration lesions (13 cases). The average time of diagnosis of the 23 patients was 8.32 days (5.0-16.0 days), and they were transferred to specialized hospitals for treatment after diagnosis. The mean time of chest drainage was 3.0-5.0 days after treatment. The average time for their body temperature to return to normal was 3.31 days (2.0-5.0 days).

Conclusion: Thoracoscopic lesions of TBP in children are varied. The use of MT is not only helpful for the early diagnosis and treatment of TBP. It also protects and improves lung function. Therefore, the use of MT has high clinical value.

Keywords: Child; diagnostic value; medical thoracoscopy; performance under thoracoscopy; tuberculous pleurisy.

Figure 1

Various pathological changes of tuberculous pleurisy under medical thoracoscopy. (a) Pleural congestion and edema. (b) Miliary nodules. (c) Encapsulated pleural effusion. (d) Cellulose exudates. (e) Cheese like spoilage. (f) Pleural hypertrophy and hyperplasia

Figure 2

Histopathological manifestations and acid-fast staining of tuberculous pleurisy. (a) Tuberculous granuloma. (b) Caseous necrosis. (c) Cellulose exudation and multinucleated giant cell infiltration. (d) Positive acid-fast staining

Figure 3

Thoracoscopic treatment of tuberculous pleurisy. (a) Chest computed tomography (CT) before treatment. (b) Pleural biopsy. (c) Loosen the adhesive joint. (d) Smooth and unobstructed lumen mucosa under bronchoscopy. (e) Chest CT after treatment