Pleural tuberculosis presented as multiple pleural masses: An atypical presentation
A 68-year-old male was admitted with complaints of gradually progressive exertional dyspnea and dry cough of three months duration. He had pleuritic chest pain, low grade fever and weight loss for one month. He was a tobacco chewer and had no history of exposure to asbestos. His physical examination was suggestive of right pleural effusion. His routine hemogram, urine examination, renal and liver function tests and coagulation profile were normal except raised erythrocyte sedimentation rate. His human immune deficiency virus and Hepatitis B surface antigen titers were negative. His echocardiogram and ultrasonography of abdomen were unremarkable. Chest X-ray was suggestive of large right-sided pleural effusion.\nAt thoracentesis, approximately 1.5 L of hemorrhagic fluid was removed. It was a lymphocytic exudate (total Protein – 3.4 g/dl, sugar – 76 mg/dl, cholesterol – 67 mg/dl, lactate dehydrogenase – 253 IU/L, adenosine deaminase – 9 IU/L, total cells – 315/cmm, polymorphs: 5%, lymphocytes: 92%, cytology – negative for malignant cells, gram stain and AFB smear – negative).\nPost-aspiration chest X-ray showed multiple irregular pleural masses []. CT of the chest revealed multiple different size masses involving the parietal as well as visceral pleura []. There were no signs of endobronchial lesions, mediastinal adenopathy or parenchymal infiltrates.\nA medical pleuroscopy was performed using a flexible bronchoscope placed through the chest tube. Multiple pleural-based (parietal as well as visceral) masses of varying sizes were observed. Histopathological examination of the pleural biopsy from a parietal pleural mass revealed epitheloid cell granulomas indicative of tuberculosis [].