Computed tomography findings of tuberculous pleurisy.

Setting: Review of the records of 491 patients with tuberculous pleurisy hospitalized between 1993 and 1995 in Izmir, Turkey. Those cases with typical histopathology or demonstrated acid-fast bacilli on pleural needle biopsies and/or positive pleural fluid/tissue cultures and available computed tomography (CT) scans are included.

Objective: To determine the CT features of tuberculosis of the pleural space.

Design: The CT scans of 66 patients with proven tuberculous pleurisy were interpreted retrospectively by three observers.

Results: Of 66 patients, 65 (98.5%) had pleural effusions; 38 (57.5%) had pleural lesions; six (9%) had involvement of interlobar fissure; and one patient (1.5%) had involvement only of the mediastinal pleura. All but one of the pleural lesions involved regular thickening of greater than 1 cm. Fibrotic parenchymal changes were seen in 11 of 66 patients (17%), cavitary changes were seen in eight (12%), and heterogeneous nodular shadows were seen in four (6%). Two cases (3%) had parenchymal consolidation and one (1.5%) had a calcified subpleural nodule. In 39% (26/66) of cases, hilar and mediastinal lymphadenopathy was identified.

Conclusion: Tuberculous pleurisy in our series was characterized on CT by the presence of pleural effusion, often with smooth pleural thickening; rarely was there involvement of the mediastinal pleura. Underlying lung parenchymal abnormalities were seen in 39% of cases. Although these findings are non-specific, they may help to distinguish tuberculous pleurisy from other causes of pleural effusion, such as malignancy.