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Tuberculous Pleural Effusion: New Pulmonary Lesions during Treatment¹

¹ From the Departments of Radiology (Y.W.C., S.C.J., H.S.S., C.K.H., K.B.J.) and Internal Medicine (S.S.P.), Hanyang University Seoul Hospital, 17 Haengdang-dong, Sungdong-ku, Seoul 133-792, South Korea; and Department of Radiology, Hanyang University Kuri Hospital, Kuri, Kyungki-do, South Korea (C.K.P.). Received July 26, 2001; revision requested September 24; revision received December 20; accepted January 22, 2002. Address correspondence to Y.W.C. (e-mail: ywchoi@hanyang.ac.kr).

PURPOSE: To evaluate patients who have a paradoxical response (development of new opacities) to treatment for tuberculous pleural effusion not related to acquired immunodeficiency syndrome.

MATERIALS AND METHODS: In 16 patients, follow-up chest radiographs (n = 16) and initial (n = 2) and follow-up (n = 9) computed tomographic (CT) scans of the chest were retrospectively reviewed by two radiologists. Patient records (n = 16) and results of percutaneous needle aspiration and/or biopsy (n = 6) were reviewed by one radiologist.

RESULTS: Eighteen episodes of new lesion development were identified on radiographs in 16 patients. Each episode showed single (nine of 18 episodes, 50%) or multiple (nine of 18 episodes, 50%) nodules, most of which were in the peripheral lung (16 of 18 episodes, 89%) ipsilateral to the side of previous effusion (17 of 18 episodes, 94%). On CT scans, all lesions were peripheral pulmonary nodules, not round atelectasis. Needle aspiration and/or biopsy of the lesions showed findings consistent with tuberculosis in all six patients. Lesions usually evolved within 3 months after the start of medication (13 of 18 episodes) and finally disappeared (15 episodes) or left residual opacities (three episodes) 3–18 months later, with continuation of medication.

CONCLUSION: New lung lesions that develop during medication for tuberculous pleural effusion should be considered a transient worsening that ultimately improves with continuation of medication.

© RSNA, 2002

Index terms: Lung, diseases, 60.234 • Lung, effects of drugs on Pleura, diseases, 66.234 • Pleura, infection, 66.234 • Tuberculosis, pulmonary, 60.234

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