Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population

Thomas, Merlin; Ibrahim, Wanis H; Raza, Tasleem; Mushtaq, Kamran; Arshad, Adeel; Ahmed, Mushtaq; Taha, Salma; Sarafandi, Saber Al; Karim, Hanfa; Abdulsattar, Hisham

doi:10.1186/s12890-017-0499-y

Cited by 24 publications

(21 citation statements)

References 12 publications

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“…However, the currently available evidence supporting this approach is limited [7]. We have shown in a previous study from this country that sago-like nodules to be among the most common Journal of Tuberculosis Research findings on gross thoracoscopic appearance of TPE cases (seen in 51% of cases) [8]. Similar results have also been reported by other investigators [7].…”

Section: Introductionsupporting

confidence: 86%

“…onstration of MTB bacilli in biopsy specimens is not an absolute requirement for making TPE diagnosis and the presence of caseating granulomatous inflammation in high burden sittings is considered adequate[4] [6][16]. In the State of Qatar, TB is a common health problem with an incidence of 40/100,000 populations per year and is the most common etiology of exudative pleural effusions accounting for 84.5% of cases[8]. About 97% of TB patients are expatriates (mostly from Asian countries with high TB prevalence)[17].…”

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confidence: 99%

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Diagnostic Utility of Sago-Like Nodules on Gross Thoracoscopic Appearance in Tuberculous Pleural Effusion and Their Correlation with Final Histo-Microbiologic Findings

Thomas¹,

Ibrahim²,

Raza³

et al. 2018

JTR

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Background: Distinguishing tuberculous pleural effusion (TPE) from other causes of exudative effusion is often challenging. Delay in treatment initiation can occur while awaiting histo-microbiologic confirmation owing to the paucibacillary nature of the disease. Sago-like nodules are the most common visual finding on gross thoracoscopic appearance. The primary objective was to determine the diagnostic utility of the presence of sago-like nodules on gross thoracoscopic appearance in TPE to help justify early initiation of tuberculosis (TB) treatment based on their finding while awaiting final histo-microbiologic confirmation. Secondary objective was to study the correlation between the presence of sago-like nodules and the final histo-microbiologic findings in pleural biopsy specimens. Methods: This was a retrospective-descriptive study of all patients with exudative pleural effusion who underwent diagnostic medical thoracoscopy (MT) at Hamad General Hospital during an eight-year period (from January, 2008 to December, 2015. Results: The presence of sago-like nodules on gross thoracoscopic appearance of the pleural surface had a sensitivity of 58%, a specificity of 89% and a positive predictive value of 97% for TPE with a diagnostic accuracy of 62%. There is significant association between the presence of sago-like nodules and demonstration of granulomatous inflammation in pleural biopsy specimens (P = 0.000). There is no association between sago-like nodules and positive TB smear and culture in biopsy specimens. Conclusion: The presence of sago-like nodules on gross How to cite this paper: Thomas, M., Ibrahim, W.thoracoscopic appearance has a high specificity and positive predictive value for TPE and significantly correlates with the presence of granulomatous inflammation. Patients from TB prevalent areas with exudative pleural effusion and sago-like nodules on gross thoracoscopic appearance may be commenced on TB chemotherapy while awaiting final histologic confirmation.

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Section: Introductionsupporting

confidence: 86%

mentioning

confidence: 99%

Diagnostic Utility of Sago-Like Nodules on Gross Thoracoscopic Appearance in Tuberculous Pleural Effusion and Their Correlation with Final Histo-Microbiologic Findings

Thomas¹,

Ibrahim²,

Raza³

et al. 2018

JTR

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“…These granulomatous lesions may grossly present as sago-like lesions in the pleura. A recent study demonstrated that sago-like nodule is the most common gross pleuroscopic nding in TB pleural effusion [18]. Our results were consistent with this nding and showed that sago-like nodule was observed in more than 70% of the patients with TB pleurisy.…”

Section: Discussionsupporting

confidence: 92%

Diagnosis of Tuberculosis Pleurisy with Three Endoscopic Features via Pleuroscopy

Lee

Chang

et al. 2020

Preprint

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Background: Tuberculosis (TB) is a constant threat even with worldwide active public health campaign. Diagnosis of TB pleurisy is challenging in case of pleural effusion of unknown origin after aspiration analysis. The study was designated to demonstrate a simple image interpretation technique to differentiate TB pleurisy from non-TB pleurisy using semi-rigid pleuroscopy. Methods: The study retrospectively enrolled 117 patients who underwent semi-rigid pleuroscopy from April 2016 to August 2018 in a tertiary hospital. We analyzed the possibility of TB pleurisy using three simple pleuroscopic images via semi-rigid pleuroscopy. Results: Among 117 patients, 28 patients (23.9%) were diagnosed with TB pleurisy. Sago-like nodules/micronodules, adhesion, and discrete distribution were noted in 20 (71.4%), 20 (71.4%), and 19 (67.9%) patients with TB pleurisy, respectively. Sago-like nodules/micronodules, adhesion, and discrete distribution were noted in 6 (6.7%), 37 (41.6%), and 0 (0.0%) patients with non-TB pleurisy, respectively. The positive and the negative predictive values of any two out of three pleuroscopic patterns for TB pleurisy were 100.0% and 93.7%, respectively. Conclusions: A high positive predictive value for TB pleurisy was demonstrated by the presence of any two out of the three characteristic features. Absence of all three features had an excellent negative predictive value for TB pleurisy. Our diagnostic criteria reconfirm that pleuroscopic images can be used as predictors for TB pleurisy.

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“…Medical thoracoscopy is an excellent diagnostic modality for exudative pleural effusion, and its yield in tuberculosis is very high. 2…”

Section: Discussionmentioning

confidence: 99%

Sago‐like appearance of pleura in Tuberculosis

Dhungana

Shrestha

2020

Clinical Case Reports

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Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population

Cited by 24 publications

References 12 publications

Diagnostic Utility of Sago-Like Nodules on Gross Thoracoscopic Appearance in Tuberculous Pleural Effusion and Their Correlation with Final Histo-Microbiologic Findings

Diagnostic Utility of Sago-Like Nodules on Gross Thoracoscopic Appearance in Tuberculous Pleural Effusion and Their Correlation with Final Histo-Microbiologic Findings

Diagnosis of Tuberculosis Pleurisy with Three Endoscopic Features via Pleuroscopy

Sago‐like appearance of pleura in Tuberculosis

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