Diagnosis of Pleural TB
in Areas with Limited Diagnostic Facilities
・Diagnosis of suspected TB empyema
- Thoracentesis to obtain pleural fluid
- AFB smear usually sufficient to make diagnosis
・Diagnosis of suspected TB pleurisy
- Chest x-ray to confirm presence of pleural fluid; lateral decubitus film helpful to check for fluid and parenchymal changes
- Thoracentesis to obtain pleural fluid only if culture facility is available or if possibility of empyema or another disease
Diagnosis & Treatment of TB Pleurisy: Practical Points
・In a high TB prevalence population, if there are no facilities for thoracentesis, you should treat a patient with a unilateral exudative pleural effusion with anti-TB drugs
・A biochemistry laboratory is not essential to diagnose an exudate. Simply leave the aspirate standing: if it clots, it is an exudate
・Empiric treatment with resolution of effusion can establish presumptive diagnosis
