Lung flukes Paragonimus heterotremus is a parasitic disease in which transmit by food, occur in 8 Northern mountainous provinces . The incidence of disease is from 0.3 to 15% on human, from 3.3 to 75% on dogs, from 8.7 to 98.1% on mountain scrab and from 1.4 to 3.6 % on snail. Clinical diagnosis based on mainly symptom such as haemoptysis or fluid pleurisy. Diagnosis definetely that have eggs of lung fluke in sputum, in fluid or in feces. Specific treatment medicine is praziquantel. Prevention of its disease by education communication for people and detective patients ealry then use specific treatment medicine
Lung ; Parasitic Diseases ; Pleurisy

PURPOSE: To describe radiologic differences between tuberculous pleural effusion and empyema on the basis of computed tomography(CT). MATERIALS AND METHODS: We reviewed retrosepectively CT findings of 50 patients with pathologically and grossly proved empyema. Twenty-two patients had empyema, and 28 patients had tuberculous pleurisy. RESULTS: CT findings known to be useful in differentiating tuberculous pleural effusion from empyema (1) contour and extent of pleural thickening, (2) mediastinal pleural involvement, (3)accumulation of extrapleural tissue and (4) change of ipsilateral thoraic volume of empyema. However, none of the above findings were helpful in the differential diagnosis of empyema. CONCLUSION: The differentation of tubrculous pleurisy from pyogenic empyema may be not possible with CT findings only.
Diagnosis, Differential ; Empyema* ; Humans ; Pleural Effusion* ; Pleurisy ; Tuberculosis, Pleural

Tuberculous (TB) pleuritis is the second most common form of extrapulmonary tuberculosis. Because the yield of pleural fluid mycobacterial culture is as low as 20% and the pleural biopsy is rather invasive, the measurement of adenosine deaminase (ADA) has been a cornerstone of the diagnosis of TB pleuritis. If the ADA level of pleural fluid is higher than 70 IU/L, the diagnosis of TB pleuritis can be made safely. The treatment is based on a standard short course anti-TB treatment starting with isoniazid, rifampicin, ethambutol, and pyrazinamide. Although systemic steroids and drainage of pleural fluid have been tried to reduce the residual pleural thickening, the results are contradicting.
Adenosine Deaminase ; Biopsy ; Drainage ; Ethambutol ; Isoniazid ; Pleural Effusion ; Pleurisy ; Pyrazinamide ; Rifampin ; Steroids ; Tuberculosis

BACKGROUND: Diagnosis of subpulmonary effusion is thought to be somewhat difficut more than pulmonary effusion. Clinical course and pathophysiology are thought to be different from typical pulmonary effusion. This study was done for increasing high suspicious index and early diagnosis of subpulmonary effusion. METHOD: Among the patients at dept. of chest medicine, National Medical Center from January 1990 to Dec. 1993, 232 cases of typical pulmonary effusion and 42 cases of subpulmonary effusion were studied. RESULT: 1) The ratio of subpulmonary effusion and typical pulmonary effusion was about 1:5 2) Male to Female ratio was 1:1 in both effusion. 3) Rt. side pleural and subpleural effusion were slightly predominant. 4) Subjective symptoms are chest pain, cough and exertional dyspnea. There is no difference between subpulmonary and typical pulmonary effusion. 5) Duration of symptom was slightly longer in subpulmonary effusion. 6) The most common cases of pleural effusion is tuberculosis in both subpulmonary & typical pulmonary effusion. Non-specific pleuritis was more common in subpulmonary effusion. 7) Pleural effusion was recurred about one fifth in both subpulmonary & pulmonary effusion. CONCLUSION: We studied clinical course and laboratory findings between subpulmonary & pulmonary effusion. However there are no definite difference between subpulmonary & pulmonary effusion. Duration of symptom was slightly longer in subpulmonary effusion. Most common cause was tuberculosis. Non specific pleuritis was more prevalent in subpulmonary effusion.
Chest Pain ; Cough ; Diagnosis ; Dyspnea ; Early Diagnosis ; Female ; Humans ; Male ; Pleural Effusion ; Pleurisy ; Thorax ; Tuberculosis

BACKGROUND: The clinical manifestation of M. tuberculosis infection ranges from asymptomatic latent infection, to focal forms with minimal symptoms and low bacterial burdens, and finally to advanced tuberculosis (TB) with severe symptoms and high bacillary loads. We investigated the diagnostic sensitivity of the whole-blood interferon-gamma release assay according to the wide spectrum of clinical phenotypes. METHODS: In patients diagnosed with active TB that underwent QuantiFERON(R) (QFT) testing, the QFT results were compared with patients known to be infected with pulmonary tuberculosis (P-TB) and extra-pulmonary TB (EP-TB). In addition, the results of the QFT test were further analyzed according to the radiographic extent of disease in patients with P-TB and the location of disease in patients with EP-TB. RESULTS: There were no statistical differences in the overall distribution of QFT results between 177 patients with P-TB and 84 patients with EP-TB; the positive results of QFT test in patients with P-TB and EP-TB were 70.1% and 64.3%, respectively. Among patients with P-TB, patients with mild extents of disease showed higher frequency of positive results of QFT test than that of patients with severe form (75.2% vs. 57.1%, respectively; p=0.043) mainly due to an increase of indeterminate results in severe P-TB. Patients with TB pleurisy showed lower sensitivity by the QFT test than those with tuberculous lymphadenitis (48.8% vs. 78.8%, respectively; p=0.019). CONCLUSION: Although QFT test showed similar results between overall patients with P-TB and EP-TB, individual sensitivity was different according to the radiographic extent of disease in P-TB and the location of disease in EP-TB.
Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Pleurisy ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

A pseudochylothorax, a chyliform pleural effusion, is a rare disease of pleural effusion that contains cholesterol crystals or high lipid content that is not the result of a disrupted thoracic duct. Most of the cases were found in patients with long-standing pleural effusion due to chronic inflammatory disease, such as old tuberculous pleurisy or chronic rheumatoid pleurisy. We experienced a case of pseudochylothorax in a 74-year-old man, who was being treated for pulmonary tuberculosis and pleurisy 10 years ago. The diagnosis was confirmed on pathological study of the pleural effusion, which contained cholesterol crystals having a diagnostic rhomboid appearance.
Aged ; Cholesterol ; Humans ; Pleural Effusion ; Pleurisy ; Rare Diseases ; Thoracic Duct ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

Arthritis, Rheumatoid ; complications ; diagnosis ; Female ; Humans ; Middle Aged ; Pleurisy ; complications ; diagnosis ; Sweet Syndrome ; diagnosis ; etiology

BACKGROUND: Determining the cause of an exudative pleural effusion is sometimes quite difficult, especially between malignant and tuberculous effusions. Twenty percent of effusions remain undiagnosed even after a complete diagnostic evaluation, including pleural biopsy. The activity of tumor necrosis factor-alpha (TNF-alpha), which is the one of proinflammatory cytokines, is increased in both infectious and malignant effusions. The aim of this study was to investigate the diagnostic efficiency of TNF-alpha activity in distinguishing tuberculous from malignant effusions. METHODS: 46 patients (13 with malignant pleural effusion, 33 with tuberculous pleural effusion) with exudative pleurisy were included. TNF-alpha concentrations were measured in the pleural fluid and serum samples using an enzyme- linked immunosorbent assay (ELISA). In addition, TNF-alpha ratio (pleural fluid TNF-alpha : serum TNF-alpha) was calculated. RESULTS: TNF-alpha concentration and TNF-alpha ratio in the pleural fluid were significantly higher in the tuberculous effusions than in the malignant effusions (p<0.05). However, the serum levels of TNF-alpha in the malignant and tuberculous pleural effusions were similar (p>0.05). The cut off points for the pleural fluid TNF-alpha level and TNF-alpha ratio were found to be 136.4 pg/mL and 6.4, respectively. The sensitivity, specificity and area under the curve were 81%, 80% and 0.82 for the pleural fluid TNF-alpha level (p<0.005) and 76%, 70% and 0.72 for the TNF-alpha ratio (p<0.05). CONCLUSION: We conclude that pleural fluid TNF-alpha level and TNF-alpha ratio can distinguish a malignant pleural effusion from a tuberculous effusion, and can be additional markers in a differential diagnosis of tuberculous and malignant pleural effusion. The level of TNF-alpha in the pleural fluid could be a more efficient marker than the TNF-alpha ratio.
Biopsy ; Cytokines ; Diagnosis, Differential* ; Humans ; Pleural Effusion ; Pleural Effusion, Malignant ; Pleurisy ; Tuberculosis ; Tumor Necrosis Factor-alpha*

Systemic lupus erythematosus (SLE) is a chronic and multisystemic disease. Pleuropulmonary disease in SLE has various clinical manifestations, such as immunologic pneumonia, infectious pneumonia, interstitial lung disease, pulmonary hypertension, pulmonary hemorrhage, pleuritis and pleural effusion. It can manifest as an initial clinical finding of SLE. We experienced two cases; one case of pulmonary hemorrhage and one case of atypical pneumonia as an initial clinical manifestation of SLE.
Hemorrhage ; Hypertension, Pulmonary ; Lung Diseases ; Lung Diseases, Interstitial ; Lupus Erythematosus, Systemic* ; Pleural Effusion ; Pleurisy ; Pneumonia

BACKGROUND: It is said that tuberculous pleuritis responds well to anti-tuberculous drug in general, so no further aggressive therapeutic management is unnecesarry except in case of diagnostic thoracentesis. But in clinical practice, we often see some patients who need later decortication due to dyspnea caused by pleural loculation or thickening despite several months of anti-tuberculous drug therapy. Therefore, we want to know the clinical difference between a group who received decortication due to complication of tuberculous pleuritis despite of anti-tuberculous drug and a group who improved after 9 months of anti-tuberculous drug only. METHODS: We reviewed 20 tuberculous pleuritis patients(group 1) who underwent decortication due to dyspnea caused by pleural loculation or severe pleural thickening despite of anti-tuberculous drug therapy for 9 or more months, and 20 other tuberculous pleuritis patients(group 2) who improved by anti-tuberculous drug only and had similar degrees of initial pleural effusion and similar age,sex distribution. Then we compared between the two groups the duration of symptoms before anti-tuberculous drug treatment and pleural fluid biochemistry like glucose, LDH, protein and pleural fluid cell count and WBC differential count, and we also wanted to know whether there was any difference in preoperative PFT value and postoperative PFT value in the patients who underwent decortication, and obtained following results. RESULTS: 1) Group 1 patients had lower glucose level{63.3+/-30.8(mg/dl)} than that of the group 2{98.5+/-34.2(mg/dl), p<0.05}, and higher LDH level{776.3+/-266.0(IU/L)} than the group 2 patients{376.3 +/-123.1(IU/L), p<0.05), and also longer duration of symptom before treatment{2.0+/-1.7(month)} than the group 2{ 1.1 +/-1.2(month), p<0.05)}, respectively. 2) In group 1, FVC changed from preoperative 2.55+/-0.80(L) to postoperative 2.99+/-0.78(L)(p<0.05), and FEV1 changed from preoperative 2.19 +/- 0.70(L/sec) to postoperative 2.50+/-0.69(L/sec) (p<0.05). 3) There was no difference in pleural fluid protein level(5.05+/-1.01(gm/dL) and 5.15+/-0.77 (gm/dl), p>0.05) and WBC differential count between group 1 and group 2. CONCLUSION: It is probable that in tuberculous pleuritis there is a risk of complication in the case of showing relatively low pleural fluid glucose or high LDH level, or in the case of having long duraton of symptom before treatment. We thought prospective study should be performed to confirm this.
Biochemistry ; Cell Count ; Drug Therapy ; Dyspnea ; Glucose ; Humans ; Pleural Effusion* ; Pleurisy ; Prospective Studies ; Tuberculosis, Pleural*