title: Tuberculous pleural effusion: new pulmonary lesions during treatment.
abstract: 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.
authors.affiliation: Department of Radiology, Hanyang University Seoul Hospital, 17 Haengdang-dong, Sungdong-ku, Seoul 133-792, South Korea. ywchoi@hanyang.ac.kr
authors.forename: Yo Won
authors.initials: YW
authors.lastname: Choi
authors.forename: Seok Chol
authors.initials: SC
authors.lastname: Jeon
authors.forename: Heung Seok
authors.initials: HS
authors.lastname: Seo
authors.forename: Choong Ki
authors.initials: CK
authors.lastname: Park
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Park
authors.forename: Chang Kok
authors.initials: CK
authors.lastname: Hahm
authors.forename: Kyung Bin
authors.initials: KB
authors.lastname: Joo
mesh_terms: 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*