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Tuberculous pleural effusion following coronary artery bypass graft
M Meysman1, D F Schoors, M Noppen
1Respiratory Division, Academic Hospital University of Brussels (AZ VUB), Belgium.
Insights
Tuberculosis can cause pleural effusion after coronary artery bypass grafting (CABG), not just post-pericardiotomy syndrome. Prompt microbiological analysis of pleural fluid is crucial for accurate diagnosis in persistent effusions post-CABG.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgical procedure.
- Post-CABG complications can include pleural effusions, often attributed to post-pericardiotomy syndrome.
- Left ventricular dysfunction is a known risk factor for cardiac surgical complications.
Observation:
- Two patients with moderate left ventricular dysfunction developed pleural effusion post-CABG.
- The pleural effusion in both cases was identified as an exudate of tuberculous origin.
- This finding challenges the assumption that all post-CABG pleural effusions are solely due to post-pericardiotomy syndrome.
Findings:
- Pleural effusions following CABG can be caused by tuberculosis.
- Tuberculous pleural effusion is a differential diagnosis to consider in post-cardiac surgery patients.
- Microbiological examination of pleural fluid is essential for identifying the etiology of unresolving effusions.
Implications:
- Clinicians should consider tuberculosis in the differential diagnosis of pleural effusions after CABG, especially in patients with unresolving effusions.
- Microbiological analysis of pleural fluid and, if necessary, pleural biopsy are recommended for accurate diagnosis.
- This case series highlights the importance of comprehensive diagnostic workup to avoid misdiagnosis and ensure appropriate treatment for post-CABG pleural effusions.
Abstract:
We present two patients with moderate left ventricular dysfunction, who developed a pleural effusion after coronary artery bypass grafting (CABG). The effusion was proven to be an exsudate of tuberculous origin. This illustrates that not all pleural exsudates developing after CABG are due to a post-pericardiotomy syndrome. Therefore microbiological examination of pleural fluid and if necessary pleural biopsy should be performed in all patients with an unresolving pleural effusion following CABG.