Early Effective Drainage in the Treatment of Loculated Tuberculous Pleurisy

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

^* To whom correspondence should be addressed. E-mail: scchang{at}vghtpe.gov.tw.

	Abstract

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

Sixty-four consecutive patients with TB pleurisy subjected to anti-TB treatment and pigtail drainage were divided into three groups: (1) 20 free-flowing effusions irrigated with saline (free-flowing group); (2) 22 loculated effusions irrigated with streptokinase (streptokinase group); and (3) 22 loculated effusions irrigated with saline (saline group). Pleural irrigation was performed for three consecutive days and effusion was 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 (RPT).

The total effusions removed were significantly greater in free-flowing (2.36±1.62 L) and streptokinase groups (2.59±1.77 L) than in saline group (1.28±1.21 L). Compared to saline group, free-flowing and streptokinase groups had significant improvement in radiological scores and forced vital capacity at different time points during follow-up and had significantly lower occurrence of RPT. All outcome variables were comparable between streptokinase and free-flowing groups.

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

This article has been cited by other articles:

				Y-F Lai, M-C Su, H-H Weng, J-T Wu, and C-T Chiu Sonographic septation: a predictor of sequelae of tuberculous pleurisy after treatment Thorax, September 1, 2009; 64(9): 806 - 809. [Abstract] [Full Text] [PDF]