Ultrasound Guided Complete Thoracentesis, Precluding Residual Pleural Thickening in Pleural Tuberculosis: A Case-Control Study

Abstract

Introduction: Pleural effusion is the commonest extra-pulmonary manifestation of tuberculosis in endemic populations. This is managed in routine, by diagnostic aspiration and treated with anti-TB medicines. A significant number of treated patients remain visiting pulmonology and thoracic surgery departments, for chest pain, abnormal chest x-ray, and shortness of breath due to residual pleural thickening (RPT).

Aims &Objectives: The study was conducted to determine the usefulness of complete thoracentesis under ultrasound guidance over diagnostic aspiration in preventing residual pleural thickening.

Place and duration of study: This case-control study was conducted from 01-07-21 to 30-06-2022 at Pulmonology- OPD of Gulab Devi Teaching Hospital Lahore-Pakistan.

Material & Methods: After approval from IRB and informed consent, 300 consecutive patients with age 14-85 years, diagnosed TB-pleural effusion, willing for intervention and participation in study were included in the study while pediatric patients, non-TB effusions and unwilling for aspiration or participation were excluded. Two groups of 150 each were allocated through odd   and even numbers. Therapeutic aspiration under ultrasound guidance for interventional group and diagnostic aspiration of 50-100 ml for control group was performed. All patients were treated with same standard and followed up according to the principles of DOTS. Pleural thickness was measured utilizing ultrasonography at day 0, 60 and 180. Outcome was compared in both groups. SPSS-24, software was utilized for analysis. p ? 0.05 was taken as significant.

Results: Only 31/150 patients (20.66%) from interventional group displayed residual pleural thickening while148/150 cases (98.66%) with residual pleural thickening were noted in control group. The P-value was 0.00001

Conclusion: Complete thoracentesis under ultrasound guidance is a tremendous tool for precluding residual pleural thickening in tubercular pleural effusions.