Comparison of Tuberculous Empyema and Tuberculous Pleurisy in Terms of Risk Factors, Radiographic Findings and Biochemical Characteristics

Abstract

Background: Tuberculous empyema and tuberculous pleurisy are caused by different pathogenic mechanisms, and are 2 distinct types of tuberculous pleural effusion that require different treatments. No previous study has analyzed the risk factors, biochemical characteristics and radiological features of the 2 entities. Methods: We studied the medical records of 84 patients with a diagnosis of tuberculous pleural effusion, who were treated between January 2002 and January 2005 in a tertiary-care hospital. There were 56 (66.7%) men and 28 (33.3%) women, with a mean age of 61.29 years. We further divided all patients into 2 groups: tuberculous empyema (n=23) and tuberculous pleurisy (n=61). We compared the risk factors, biochemical characteristics, and radiological features between these 2 groups. Results: Among the 84 patients, the most common risk factors were diabetes mellitus (n=11), neoplasia (n=6), and alcoholism (n=4). There were no statistically significant differences in risk factors and radiographic findings between the 2 groups. The similar biomedical characteristics of tuberculous pleurisy and tuberculous empyema were the high LDH level (322.80±190.42, 530.88±71.79U/L, respectively, p=0.14), high adenosine deaminase (ADA) activity (53.50±21.6, 54.6±11.6U/L, respectively, p=0.942) and high percentage of lymphocyte counts (82.71±21.62, 76.34±18.22%, respectively, p=0.538). The only statistically different biomedical characteristic between the 2 groups was the red blood cell (RBC) count in the pleural fluids, which was significantly higher in tuberculous empyema than in tuberculous pleurisy (41.28±123.52vs. 9.68±27.36 10^3/UL, respectively, p＜0.05). Conclusion: When a patient presents with tuberculous pleural effusion that is lymphocyte- predominant, and has a high ADA activity and bloody appearance, tuberculous empyema should be highly suspected.