Cases reported "Tuberculosis, Pleural"

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1/23. Pseudochylothorax. Report of 2 cases and review of the literature.

    We report 2 cases of pseudochylothorax and review 172 published cases. tuberculosis is by far the most frequent cause of pseudochylothorax, accounting for 54% of all caes, with a remarkable association with previous collapse therapy and long-term effusions. The remaining etiologies, including rheumatoid arthritis, are infrequent. Tuberculous pseudochylothorax is usually sterile. Successful treatment of an acute tuberculous pleurisy does not preclude the development of long-term complications such as pseudochylothorax. We do not recommend pleural biopsy initially because of its low yield for etiologic diagnosis. Currently, adenosine deaminase (ADA) values in pleural fluid are not useful to sustain diagnosis or therapeutic decisions. We advise draining only symptomatic cases and treating patients with positive Ziehl-Neelsen stain or Lowenstein culture, and those with growing effusions of suspected tuberculous origin, with antituberculous chemotherapy. Pulmonary decortication should be the last therapeutic step for recurrent and symptomatic cases.
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ranking = 1
keywords = effusion
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2/23. Mesothelial cells in tuberculous pleural effusions of hiv-infected patients.

    The scarcity of mesothelial cells is a well-known characteristic of tuberculous pleural effusions. We report three hiv-infected patients with tuberculous pleural effusions, in which mesothelial cells were found in significant numbers in the pleural fluid. Clinicians should be aware that the altered immune responses that occur in hiv-infected patients may affect the cytologic profile of tuberculous pleural effusions, and they should be cautious not to exclude this diagnosis based solely on the presence of mesothelial cells in the fluid.
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ranking = 3.5
keywords = effusion
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3/23. A 73-year-old man with chronic lymphocytic leukaemia and a haemorrhagic pleural effusion.

    A 73-year-old man presented with haemorrhagic pleural effusion, having been diagnosed with chronic lymphocytic leukaemia (CLL). The differential diagnosis of haemorrhagic pleural effusion is considered. tuberculosis and pleural infiltration of CLL are considered most likely. Pleural biopsy confirms the diagnosis of pleural involvement of CLL in this case. Although pleural involvement of CLL has been reported several times the presentation of pleural effusion as the first symptom of CLL has not previously been described.
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ranking = 3.5
keywords = effusion
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4/23. Multiple pleural nodules without effusion--a rare presentation of tuberculous pleurisy.

    We report a rare case of tuberculous pleurisy presenting with multiple pleural nodules without associated effusion or parenchymal lung lesions. A 62-year-old man had multiple discrete pleural nodules in the right hemithorax on chest radiography without any clinical symptoms. Thoracoscopic biopsy of the pleural nodules revealed a caseous granuloma with acid-fast bacilli. The patient received antituberculous therapy, with resolution of tuberculomas on chest film within 2 months. To our knowledge, only two similar cases have been previously reported in the English literature, and our observation should lead to broadening of the spectrum of the differential diagnosis of multiple pleural nodules.
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ranking = 2.5
keywords = effusion
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5/23. Development of contralateral pleural effusion during chemotherapy for tuberculous pleurisy.

    Paradoxical worsening of tuberculous lesions, despite effective chemotherapy, has been reported in intracranial tuberculomas, lymph nodes, pulmonary disease, and tuberculous pleurisy. However, development of contralateral pleural effusion during treatment of tuberculous pleurisy is very rare. We report the case of a 22 year old female patient who presented with right sided pleural effusion and was treated with antituberculous drugs. Four weeks later although her right sided pleural effusion was subsiding she developed a left sided pleural effusion. Closed pleural biopsy on the left side showed granulomatous inflammation with early caseation. Antituberculous drugs were continued and a short course of oral prednisolone was added. She recovered completely and her chest x-ray became normal after finishing her treatment.
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ranking = 4
keywords = effusion
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6/23. Increased pleural fluid adenosine deaminase in brucellosis is difficult to differentiate from tuberculosis.

    Pleural involvement in brucellosis is very rare. Current knowledge on brucella pleuritis is limited to a few case studies, and pleural adenosine deaminase (ADA) in brucellosis has not been studied previously. We report the pleural fluid characteristics, including ADA, of two cases with brucella pleurisy. Analysis of the pleural fluids revealed exudative effusions with increased ADA level, decreased glucose concentration, and lymphocyte predominance. The similarity with tuberculous pleurisy was remarkable. We suggest that brucellosis should be considered in the differential diagnosis of tuberculosis, especially in regions endemic for both diseases.
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ranking = 0.5
keywords = effusion
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7/23. abdominal wall abscess secondary to subcapsular tubercular liver abscess.

    We report a 22-year-old woman who presented with an abdominal wall lump in the right upper quadrant 15 days after starting antitubercular treatment for right pleural effusion. CT scan revealed a right liver lobe subcapsular abscess communicating vith subcutaneous tissue. Aspiration of pus revealed acid-fast bacilli. She responded to 9 months of antitubercular treatment.
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ranking = 0.5
keywords = effusion
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8/23. tuberculosis in a contact.

    A 12 year old girl developed a large tuberculous pleural effusion. She was a contact of an adult with pulmonary tuberculosis who was positive on smear testing, and she had been managed in accordance with current British Thoracic Society recommendations.
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ranking = 0.5
keywords = effusion
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9/23. pleural effusion associated with aortitis syndrome.

    A patient with aortitis syndrome had a pleural effusion which subsided but reappeared with an exacerbation of aortitis symptoms while under antituberculosis treatment. The character of the fluid was that of an exudate, and the glucose concentration was normal. Clinical and laboratory features of the case suggest that the effusion was part of the aortitis syndrome per se.
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ranking = 3
keywords = effusion
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10/23. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Study of 414 patients.

    This article describes the results of a dual diagnostic procedure, thoracentesis and pleural biopsy with a Cope's needle, in 414 patients with pleural effusion of unknown origin. A diagnosis of neoplasia or pleural tuberculosis was obtained in 241 subjects (149 with neoplasias and 92 with pleural tuberculosis). In an additional 55 patients, a diagnosis of tuberculosis or neoplasia was obtained using other procedures (15 with tuberculosis and 40 with neoplasias). In 105 subjects, the effusion was neither tuberculosis nor neoplasia. Thirteen patients were excluded from this study due to the impossibility of follow-up. The diagnostic process was repeated in 64 patients. Complications occurred in 46 patients (11%), of which 42 were pneumothorax. The dual diagnostic sensitivity in our series of thoracenteses and pleural biopsies made with a Cope's needle was 86% in tuberculosis and 79% in neoplasia with 100% specificity. The probability of a case being neither tuberculosis nor pleural neoplasia (negative predictive value) when the liquid and the pleural biopsy specimen are nonspecific (each procedure having been applied only once on each patient) is 56%, although a negative result does not exclude these diagnoses. In our opinion, the repetition of the dual procedure is indicated considering the scant morbidity and zero mortality.
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ranking = 1
keywords = effusion
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