title: The visual diagnosis of tuberculous pleuritis under medical thoracoscopy: a retrospective series of 91 cases.
abstract: BACKGROUND
  Despite progress of medical, the fast and accurate diagnosis of tuberculous pleuritis (TP) continues to be a challenge, mainly because of the lack of specific clinical features and the difficulty in isolating the Mycobacterium tuberculosis.
  
  
  OBJECTIVE
  To investigate the role of medical thoracoscopy in definite diagnosis of tuberculous pleuritis, especially the feature of visual diagnosis in tuberculous pleuritis via medical thoracoscopy. We performed a retrospective review of the utility of medical thoracoscopy in tuberculous pleuritis.
  
  
  METHODS
  A retrospective chart review was performed of 91 patients who had medical thoracoscopy for suspected TP at the Second Xiangya Hospital from October 1, 2006 to July 30, 2012.
  
  
  RESULTS
  In ninety one cases, 76 patients were diagnosed with TP by pathologic diagnosis. The visual findings via thoracoscopy of 76 TP patients included the following: (1) necrosis (76.32%, n=58), (2) diffuse miliary nodules (64.67%, n=49), (3) single or multiple pleural nodules (14.47%, n=11), (4) hyperemic, edematous and thickened pleura (56.58%, n=43), and (5) pleural adhesions or fibrotic septa (78.95%, n=60), and all of these samples had hydrothorax or loculated effusion. The diagnostic efficiency of visual diagnosis via medical thoracoscopy about tuberculous pleuritis was 93.41%. In the non-invasive test, ADA > 40 u/l with LDH > 200 u/l for TP showed relatively high sensitivity and specificity (73.68%, 80.00%, respectively).
  
  
  CONCLUSIONS
  TP presents a variety of scopic phenotypes under medical thoracoscopy. The experienced pulmonologists visually diagnose TP efficiently and directly via medical thoracoscopy. Medical thoracoscopy with combined biopsy is an accurate and safe method for diagnosing TP.
authors.affiliation: Department of Respiratory Medicine, the Frist Hospital of Changsha, Changsha, Hunan, China. luohong1003@163.com.
authors.forename: X-L
authors.initials: XL
authors.lastname: Kong
authors.forename: H-H
authors.initials: HH
authors.lastname: Zeng
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: T-T
authors.initials: TT
authors.lastname: Liu
authors.forename: Z-H
authors.initials: ZH
authors.lastname: Shi
authors.forename: D-Y
authors.initials: DY
authors.lastname: Zheng
authors.forename: R
authors.initials: R
authors.lastname: Zhou
authors.forename: S
authors.initials: S
authors.lastname: Cai
authors.forename: P
authors.initials: P
authors.lastname: Chen
authors.forename: H
authors.initials: H
authors.lastname: Luo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000706:statistics & numerical data*; D014396:Tuberculosis, Pleural / Q000175:diagnosis*; D055815:Young Adult