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Abstract SUMMERY The purpose of this study was to evaluate the incidence of tuberculous pleurisy diagnosed with medical thoracoscopy in patients with exudative effusion and low adenosine deaminase level. A cross sectional study was conducted on 85 patients with exudative pleural effusion with ADA level below 40 IU/L. All patients subjected to the following: Full history taken. Clinical examination Laboratory examination including: - liver function tests kidney function tests CBC ESR Sputum analysis for AFB TST ( Tuberculin in skin test ) Chest X – rays ,CT chest Thoracocentesis for; Protein-glucose-LDH- - Adenosine Deaminase (ADA) Pleural fluid smear for AFB, Total and Differential cell counts, pH, culture and sensitivity. Cytological examination for malignant cells. 8- Medical Thoracoscopy for inspections of pleural cavity and taking biopsies from parietal pleural. We classified the patients as regarding the diagnosis based on thoracoscopic biopsy into two groups; group (A): TB group (41 cases) group (B): non-TB group (44 cases); (23/44) mesothelioma, (11/44) adenocarcinoma and (10/44). (nonspecific pleuritis) This study revealed the following results: The mean age of the studied patients was (40.34±15.89) years, 60% of them was males. The most common complain of patients were dyspnea and cough (76.5% and 74.1%) respectively, followed by chest pain (44.7) %, toxic symptoms (35.3) % and expectoration (31.8) %, the less common presentation was haemoptysis (8.2) %. The mean level of ADA in pleural effusion (23.2±9.9) IU/L Thoracoscopic finding: (23/85) patients had thickened both pleurae with simple adhesion, (23/85) patients had thickened both pleurae and multiple variable size nodules, (15/85) had thickened parietal pleurae with tiny and small nodules, (13/85) had apparently health pleura with hyperaemia areas and (11/85) had multiple large nodules up to masses. The mean age in TB group about (29±10.7) years while in non TB group about (50.9±12.3) years with significant statistical difference, p value=0.0001. No significant association of sex, clinical presentation with any groups. A significant statistical difference between the two groups as regarding; TLC and TST present, p value = (0.008 and 0.0001) respectively, while no significant statistical difference as regarding PLT, Create, AST and ALT, p value = (0.6, 0.9, 0.3 and 0.1) respectively. Significant statistical difference between the two groups as regarding ADA level in effusion, p value = 0.009. Significant association of pleural thickening with simple adhesion and thickened with tiny and small nodules with TB pleural effusion, while the other picture most commonly associated with nontuberculous pleural effusion, p value= 0.0001. Cut off point level of ADA in effusion (28.7) IU/L, equal and above this level the sensitivity was 73.1%, specificity was 100%, PPV was 100%, NPV was 80% and accuracy of this test was 87%. |