Computed tomography findings of tuberculous pleurisy

Review of the records of 491 patients with tuberculous pleurisy hospitalized between 1993 and 1995 in Izmir, Turkey. Those cases with typical histopathology or demonstrated acid-fast bacilli on pleural needle biopsies and/or positive pleural fluid/tissue cultures and available computed tomography (CT) scans are included.

To determine the CT features of tuberculosis of the pleural space.

The CT scans of 66 patients with proven tuberculous pleurisy were interpreted retrospectively by three observers.

Of 66 patients, 65 (98.5%) had pleural effusions; 38 (57.5%) had pleural lesions; six (9%) had involvement of interlobar fissure; and one patient (1.5%) had involvement only of the mediastinal pleura. All but one of the pleural lesions involved regular thickening of greater than 1 cm. Fibrotic parenchymal changes were seen in 11 of 66 patients (17%), cavitary changes were seen in eight (12%), and heterogeneous nodular shadows were seen in four (6%). Two cases (3%) had parenchymal consolidation and one (1.5%) had a calcified subpleural nodule. In 39% (26/66) of cases, hilar and mediastinal lymphadenopathy was identified.

Tuberculous pleurisy in our series was characterized on CT by the presence of pleural effusion, often with smooth pleural thickening; rarely was there involvement of the mediastinal pleura. Underlying lung parenchymal abnormalities were seen in 39% of cases. Although these findings are non-specific, they may help to distinguish tuberculous pleurisy from other causes of pleural effusion, such as malignancy.