THE RELIABILITY OF TISSUE DIAGNOSIS OF PLEURISY: A PRELIMINARY REPORT

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Abstract
Pleural biopsies were obtained on 46 males with unexplained pleurisy and positive tuberculin skin tests by 1 or more of 3 methods, needle biopsy, limited thoracotomy and full thoracotomy. Twenty-four had organized epithelioid cell tubercles (granulomas) on microscopic examination of tissue. Acid-fast organisms resembling Mycobacterium tuberculosis were recovered from 16 of these individuals. No organisms were recovered from the 22 patients with nongranulomatous pleuritis. The usual long-term antituberculosis chemotherapy was administered to the granulomatous cases but was withheld or discontinued in the others. On preliminary follow-up of the nongranulomatous cases (50% were followed at least 6 months), there were no relapses with active tuberculosis. It was found that 75% of the patients with a granulomatous pleuritis were under 25 years of age, compared to 18% of the nongranulomatous group. Clinically, those with a granulomatous pleuritis were more symptomatic at the time of admission.[long dash]The most reliable biopsy technique is the full thoracotomy. However, when positive, the needle biopsy or limited thoracotomy are adequate and their simplicity is a distinct advantage. These preliminary results indicate that tissue diagnosis of pleurisy is a reliable means of selecting the cases that should be treated for tuberculosis.

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