AM report 10/31/16 Pleural Tb

Most common etiologies for BLOODY pleural effusion

-Trauma
-Malignancy
-Pulmonary infarction
-Post-cardiac injury

Differential for Lymphocytic Exudative pleural effusion

TUBERCULOSIS
-Malignancy (Lung> BRCA, lymphoma, ovarian/gastric)
-Sarcoid
-Rheumatoid pleurisy
-Chylothorax

Workup of Suspected Pleural Tb

-Exudative lymphocytic pleural effusion, <10 % eosinophils
-High LDH (usually >500)
-AFB stain and culture (only positive 20-30 % of the time)
-Adenosine deaminase- HIGH sensitivity (if <40) and HIGH specificity (if >60), however depends on laboratory validity
-Pleural biopsy (positive 60-90 %)- can be done either via thoracoscopy or percutaneous needle biopsy)

Treatment
-Airborne isolation (~50 % of patients with concomitant Pulmonary Tb)
-RIPE therapy (similar to pulmonary Tb)

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