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Early effective drainage in the treatment of loculated tuberculous pleurisy

¹ Dept of Chest Medicine, Taipei Medical University Hospital, ² Graduate Institute of Clinical Medicine, and ³ Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, ⁴ Chest Department, Taipei Veterans General Hospital, and ⁵ Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan.

CORRESPONDENCE: S-C. Chang, Chest Department, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Shih-Pai, Taipei 112, Taiwan. Fax: 886 228752380. E-mail: scchang{at}vghtpe.gov.tw

Keywords: Loculated pleural effusion, pigtail drainage, pleural effusion, pleural thickening, tuberculosis

Received: September 15, 2007
Accepted January 10, 2008

The role of early effective drainage in loculated tuberculous (TB) pleurisy treatment remains unclear.

Consecutive patients with TB pleurisy subjected to anti-TB treatment and pigtail drainage (n = 64) were divided into three groups: 1) patients with free-flowing effusions irrigated with saline (free-flowing group; n = 20); 2) patients with loculated effusions irrigated with streptokinase (streptokinase group; n = 22); and 3) patients with loculated effusions irrigated with saline (saline group; n = 22). Pleural irrigation was performed for 3 days consecutively and the effusion drained as completely as possible. Outcomes were assessed for 12 months by clinical symptoms, effusion removed, radiological scores for effusion amount, lung function and occurrence of residual pleural thickening.

The total effusion volumes removed were significantly greater in the free-flowing (2.36±1.62 L) and streptokinase groups (2.59±1.77 L) than in the saline group (1.28±1.21 L). Compared with the saline group, the free-flowing and streptokinase groups showed significant improvement in radiological scores and forced vital capacity at different time-points during follow-up, and a significantly lower occurrence of residual pleural thickening. All outcome variables were comparable between the streptokinase and free-flowing groups.

In summary, early effective drainage and complete anti-tuberculosis treatment may hasten clearance of pleural effusion, reduce residual pleural thickening occurrence and accelerate pulmonary function recovery in patients with symptomatic loculated tuberculous pleurisy.