Diagnosing value of closed-pleural biopsy in pleural tuberculosis
2012
Introduction: Thoracoscopy is the gold standard for diagnosis of pleural tuberculous (PTB). However, pleural biopsy (PB) is a blind technique of investigation of simple first intension designed to make the histological diagnosis. to evaluate the contribution of PB in the histological diagnosis of PTB. We study retrospectively 49 patients in whom PTB were diagnosed in our military department. PB was sent for culture and histopathological examination. Patients were excluded if they had positive basciloscopy. Results: The mean age was 32 years (12 to 78). 81% were male. A past medical history of tuberculosis was found in 25% of cases. The most frequent symptoms are: chest pain, cough and constitutional symptoms. The TB effusions were all exudative with a mean lymphocyte fraction of 80%. PB was done in 89% of cases with a mild number of fragments was 4,5. Diagnosis was confirmed by closed-PB in 61,9% of cases, boxes from the first biopsy in 53.3% of cases. Thus the sensitivity of the PB is 53%. No complications of PB were noted. The thoracoscopy confirm the diagnosis in 24,4% of cases. 4,4% of cases was histologically non diagnostic. Pleurisy is isolated in 77.5% of cases associated with pericardial disease in 6.1% of cases. Histology found a tuberculous granuloma in 69% of cases with caseous necrosis in 50% of cases. Culture of pleural fragment was positive in 3 cases. In other cases the diagnosis is retained on elements of presumptions. Conclusion: The profitability of PB depends on the extent of lesions and the experience of the operator. The PB is a minimally invasive and cost effective for the early diagnosis of pleural tuberculosis before considering more invasive examinations.
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