Abstract
Introduction
Empyema thoracis remains a major problem in developing countries. Clinical outcomes in tuberculous empyema are generally believed to be worse than in non-tuberculous. So with the help of Abram pleural biopsy early detection of the cause of empyema and its treatment could be possible.
Objectives
To evaluate the role of Abram's pleural biopsy in determining the cause of empyema thoracis.
Methods
A prospective study of patient's data was undertaken at the Pulmonology department at the largest public tertiary care centre in Karachi, Pakistan. Pleural biopsies for histopathology were obtained using Abram's pleural biopsy needle from 46 patients admitted with empyema thoracis between August 2010 and August 2011; along with pus for Gram staining, routine culture, AFB smear and AFB culture, and the results of these variables were compared for diagnostic efficiency.
Results
A comparison of the diagnostic tools used showed positive Gram staining in 28 out of 46 (60.9%) cases. Bacterial cultures were positive in 24 (52.1%) of the cases, with 10 (21.7%) positive for Streptococcus pneumonia, 8 (17.4%) positive for Pseudomonas aeruginosa, 6 (13%) positive for Staphylococcus aureus; and 15 (32.6%) with AFB growth on pus culture. Only 4 (8.6%) had a positive AFB smear. Whereas histopathology revealed 28 (60.9%) cases as having acute on chronic pyogenic inflammation, 12 (26.1%) with chronic non-specific inflammation, and 6 (13%) with acute on chronic granulomatous inflammation.
Conclusions
In comparison to other diagnostic techniques, there is no benefit of performing Abram's pleural biopsy in determining the cause of empyema thoracis. Pus culture has a better yield in specifying the cause in most cases.
- © 2012 ERS