Neutrophilic loculated tuberculous pleural effusion: Incidence, characteristics and differentiation from complicated parapneumonic effusion

Jaehee Lee, Jae Kwang Lim, So Yeon Lee, Seung Soo Yoo, Shin Yup Lee, Seung Ick Cha, Jae Yong Park, Chang Ho Kim

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objectives: Tuberculous pleural effusion (TPE) is generally characterized by lymphocytic exudative effusion, either free-flowing or loculated. However, patients can also have neutrophilic loculated TPE, although little data are available concerning the incidence and characteristics of this form of TPE. It is important to differentiate between neutrophilic loculated TPE and complicated parapneumonic effusion (PPE), which also shows neutrophilic loculated effusion but needs a different management approach. The present study evaluated the incidence and characteristics of neutrophilic loculated TPE and differentiated it from complicated PPE. Materials and Methods: Between 2009 and 2014, a cohort of patients with TPE was retrospectively reviewed in a South Korean referral hospital. Clinical, laboratory, computed tomography and pleural fluid findings of patients with neutrophilic loculated TPE were compared to those of patients with neutrophilic free-flowing TPE and complicated PPE, respectively. Results: Neutrophilic TPE was observed in 33 (10%) out of 344 patients with TPE. Of these, 10 (30%) patients exhibited loculation of the pleural fluid. These patients showed distinct pleural fluid characteristics. The classical pleural fluid biomarker levels were more intense than those observed in 23 patients with neutrophilic free-flowing TPE, but similar to those of 54 patients with complicated PPE. A high mycobacterial burden was observed in the pleural fluid, and favorable outcomes were achieved with antituberculosis drug administration alone. Nodular parenchymal lesions and pleural fluid adenosine deaminase levels were independent discriminators of neutrophilic loculated TPE and PPE. Conclusions: These results may be helpful to understand and manage patients with neutrophilic loculated TPE and differentiate them from patients with complicated PPE.

Original languageEnglish
Pages (from-to)153-159
Number of pages7
JournalAmerican Journal of the Medical Sciences
Volume351
Issue number2
DOIs
StatePublished - 2016

Keywords

  • Adenosine deaminase
  • Complicated parapneumonic effusion
  • Loculation
  • Neutrophilic tuberculous pleural effusion

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