Background: Distinguishing tuberculous pleural effusion (TPE) from other\ncauses of exudative effusion is often challenging. Delay in treatment initiation\ncan occur while awaiting histo-microbiologic confirmation owing to the paucibacillary\nnature of the disease. Sago-like nodules are the most common visual\nfinding on gross thoracoscopic appearance. The primary objective was to\ndetermine the diagnostic utility of the presence of sago-like nodules on gross\nthoracoscopic appearance in TPE to help justify early initiation of tuberculosis\n(TB) treatment based on their finding while awaiting final histo-microbiologic\nconfirmation. Secondary objective was to study the correlation between the\npresence of sago-like nodules and the final histo-microbiologic findings in\npleural biopsy specimens. Methods: This was a retrospective-descriptive\nstudy of all patients with exudative pleural effusion who underwent diagnostic\nmedical thoracoscopy (MT) at Hamad General Hospital during an eight-year\nperiod (from January, 2008 to December, 2015). Results: The presence of sago-\nlike nodules on gross thoracoscopic appearance of the pleural surface had\na sensitivity of 58%, a specificity of 89% and a positive predictive value of 97%\nfor TPE with a diagnostic accuracy of 62%. There is significant association\nbetween the presence of sago-like nodules and demonstration of granulomatous\ninflammation in pleural biopsy specimens (P = 0.000). There is no\nassociation between sago-like nodules and positive TB smear and culture in\nbiopsy specimens. Conclusion: The presence of sago-like nodules on gross thoracoscopic appearance has a high specificity and positive predictive value\nfor TPE and significantly correlates with the presence of granulomatous inflammation.\nPatients from TB prevalent areas with exudative pleural effusion\nand sago-like nodules on gross thoracoscopic appearance may be commenced\non TB chemotherapy while awaiting final histologic confirmation.
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