What is Tuberculous pleural effusion (TPE)?

While Tuberculosis (TB) is curable, it remains a disease that affects thousands of South Africans. Pleural effusion is an unusual amount of fluid which builds up between the layers of pleura which covers the surface of the lungs. While it can be caused by pneumonia, cancer and autoimmune conditions such as lupus or rheumatoid arthritis, TB remains the biggest cause of pleural effusion. Tuberculous pleural effusion (TPE) is one of the most common forms of extra-pulmonary tuberculosis and takes the symptoms of acute infection in which pleuritic chest pain, fever and cough are common.

How can Tuberculous (TB) be diagnosed?

Diagnosing Tuberculosis (TB) can be tricky since the test results from the blood test can be wrong due to various factors that involve the immune system and previous vaccinations. Sometimes those who have TB receive negative results, while others receive positive results only to find these results were wrong. For this reason, further diagnostic tests may need to be done to be sure about diagnosis. Diagnosis for TB Pleural-parenchymal may include the following:

  • A bronchoscopy – this test is done by threading a bronchoscope into your nose down your throat and into the lungs. The bronchoscope has a camera fitted to the end in order to view the inside of the lungs. At the same time, your doctor may use a needle attached to the bronchoscope to take samples of the tissue to diagnose you accurately.
  • A mediastinoscopy – this is a diagnostic procedure done on mediastinal lymph nodes. Under general anaesthesia, Dr Scott will make an incision in the breastbone and use a mediastinoscope which is a thin tube with a camera at the end to better view the internal workings of the lymph nodes and take a sample of the tissue from them.
  • A pleural effusion drainage – this procedure is done to remove the fluid from the space between your lungs and chest cavity. Under general anaesthesia, using a needle or a small tube called a thoracoscope, which is inserted into the chest, the fluid is removed.
  • Thoracoscopic lung biopsies – this diagnostic procedure involves a thin tube with a camera, called a thoracoscope, to be used in order to inspect the lungs and take a sample of tissue from the lungs to test.

Dr Scott performs these comprehensive diagnostic procedures to validate diagnosis and also to evaluate what strain of TB may be present and whether or not the person may only have latent TB infection or if the infection has progressed to TB disease. From these diagnostic tests, your cardiothoracic surgeon may advise on the most suitable treatment method.

What will treatment entail?

  • Lobectomies or pneumonectomies for TB bronchiectasis
    Bronchiectasis is a secondary condition caused by TB in which the bronchi become permanently infected and inflamed leading to destruction of the bronchial wall. It involves repeated respiratory infections which leads to excessive mucus being produced in the bronchi by the cells lining the bronchi which causes infection when build-up occurs. While there is no cure for this condition, surgery such as a lobectomy or pneumonectomy may be suggested to remove the affected area of the lung.
  • Decortications TB Empyemas
    Tubercular empyema is a chronic infection of the lungs due to tubercle bacilli caused by TB. The treatment involves surgical decortication of the lung which involves the removal of the thickened pleura and empyema in order to enhance respiratory functioning. In some cases, resection of the diseased parts of the lung may be needed.