The visual diagnosis of tuberculous pleuritis under medical thoracoscopy: a retrospective series of 91 cases.

BACKGROUND: Despite progress of medical, the fast and accurate diagnosis of tuberculous pleuritis (TP) continues to be a challenge, mainly because of the lack of specific clinical features and the difficulty in isolating the Mycobacterium tuberculosis.

OBJECTIVES: To investigate the role of medical thoracoscopy in definite diagnosis of tuberculous pleuritis, especially the feature of visual diagnosis in tuberculous pleuritis via medical thoracoscopy. We performed a retrospective review of the utility of medical thoracoscopy in tuberculous pleuritis.

PATIENTS AND METHODS: A retrospective chart review was performed of 91 patients who had medical thoracoscopy for suspected TP at the Second Xiangya Hospital from October 1, 2006 to July 30, 2012.

RESULTS: In ninety one cases, 76 patients were diagnosed with TP by pathologic diagnosis. The visual findings via thoracoscopy of 76 TP patients included the following: (1) necrosis (76.32%, n=58), (2) diffuse miliary nodules (64.67%, n=49), (3) single or multiple pleural nodules (14.47%, n=11), (4) hyperemic, edematous and thickened pleura (56.58%, n=43), and (5) pleural adhesions or fibrotic septa (78.95%, n=60), and all of these samples had hydrothorax or loculated effusion. The diagnostic efficiency of visual diagnosis via medical thoracoscopy about tuberculous pleuritis was 93.41%. In the non-invasive test, ADA > 40 u/l with LDH > 200 u/l for TP showed relatively high sensitivity and specificity (73.68%, 80.00%, respectively).

CONCLUSIONS: TP presents a variety of scopic phenotypes under medical thoracoscopy. The experienced pulmonologists visually diagnose TP efficiently and directly via medical thoracoscopy. Medical thoracoscopy with combined biopsy is an accurate and safe method for diagnosing TP.