Tuberculous pleural effusion: new pulmonary lesions during treatment.
OBJECTIVE
To evaluate patients who have a paradoxical response (development of new opacities) to treatment for tuberculous pleural effusion not related to acquired immunodeficiency syndrome.


METHODS
In 16 patients, follow-up chest radiographs (n = 16) and initial (n = 2) and follow-up (n = 9) computed tomographic (CT) scans of the chest were retrospectively reviewed by two radiologists. Patient records (n = 16) and results of percutaneous needle aspiration and/or biopsy (n = 6) were reviewed by one radiologist.


RESULTS
Eighteen episodes of new lesion development were identified on radiographs in 16 patients. Each episode showed single (nine of 18 episodes, 50%) or multiple (nine of 18 episodes, 50%) nodules, most of which were in the peripheral lung (16 of 18 episodes, 89%) ipsilateral to the side of previous effusion (17 of 18 episodes, 94%). On CT scans, all lesions were peripheral pulmonary nodules, not round atelectasis. Needle aspiration and/or biopsy of the lesions showed findings consistent with tuberculosis in all six patients. Lesions usually evolved within 3 months after the start of medication (13 of 18 episodes) and finally disappeared (15 episodes) or left residual opacities (three episodes) 3-18 months later, with continuation of medication.


CONCLUSIONS
New lung lesions that develop during medication for tuberculous pleural effusion should be considered a transient worsening that ultimately improves with continuation of medication.
Choi
Yo Won
YW
Department of Radiology, Hanyang University Seoul Hospital, 17 Haengdang-dong, Sungdong-ku, Seoul 133-792, South Korea. ywchoi@hanyang.ac.kr
Jeon
Seok Chol
SC
Seo
Heung Seok
HS
Park
Choong Ki
CK
Park
Sung Soo
SS
Hahm
Chang Kok
CK
Joo
Kyung Bin
KB
D000328:Adult; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000209:etiology; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*