Abstract
Pleural biopsies are especially indicated in the following circumstances: (a) inconclusive pleural fluid analysis and negative sputum study, if adenosine deaminase (ADA) levels are unavailable; (b) suspected multi-resistant tuberculosis; (c) a need for differentiating tuberculous pleurisy (if it progresses with neutrophilia) and complicated parapneumonic effusion; (d) malignant pleural effusion coexisting with very high ADA levels; (e) effusion coexisting with lung cancer and negative pleural cytology; (f) suspected mesothelioma; and (g) need for implementing re-treatment for patients with relapse after chemotherapy. Image-guided needle biopsy is recommended for cases a and b, while thoracoscopy is preferable for the other cases.
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