Phlegmonous Appearance in the Ipsilateral Paracardiac Fat without Paracardiac Lymph Node Enlargement on Chest CT Favors the Diagnosis of Pleural Tuberculosis over Malignant Pleural Effusion
JournalDiagnostics (Basel, Switzerland)
MetadataShow full item record
AbstractThis study investigated the potential role of paracardiac fat stranding (FS) interspersed with multiple fluid collections (FC) as a clue to differentiate between pleural tuberculosis (pleural TB) and malignant pleural effusion (MPE). The authors retrospectively analyzed chest computed tomography (CT) findings of 428 patients, 351 with pleural TB and 77 with MPE, focusing on the paracardiac fat, and level of pleural adenosine deaminase (ADA) and blood C-reactive protein (CRP). Two radiologists independently evaluated the chest CT findings regarding the paracardiac fat pad ipsilateral to the effusion, including FS, FC, phlegmonous appearance (a combination of the FS and multiple FC), and the presence of lymph node enlargement (>1 cm in short axis diameter). There were significant differences between patients with pleural TB and those with MPE with respect to the prevalence of phlegmonous appearance in the ipsilateral paracardiac fat (47.6% and 10.4%, p < 0.001, OR = 7.8; 95% CI 3.7-16.8) and paracardiac lymph node enlargement (1.4% and 19.5%, p < 0.001, OR = 0.06; 95% CI 0.02-0.2) on CT. In contrast, there was no difference in the prevalence of isolated FS or multiple FC within the ipsilateral paracardiac fat between the two groups. Median pleural ADA and serum CRP level were higher in patients with pleural TB accompanied by phlegmonous appearance in paracardiac fat compared to those without that appearance (ADA: median 104 IU/L versus 90 IU/L, p < 0.001; CRP: 6.5 mg/dL versus 4.2 mg/dL, p < 0.001). In conclusion, phlegmonous appearance in the ipsilateral paracardiac fat without paracardiac lymph node enlargement on chest CT favors a diagnosis of pleural TB over MPE.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/16173
- Paracardiac adenopathy: CT evaluation.
- Authors: Sussman SK, Halvorsen RA Jr, Silverman PM, Saeed M
- Issue date: 1987 Jul
- Predictive role of adenosine deaminase for differential diagnosis of tuberculosis and malignant pleural effusion in Turkey.
- Authors: Yildiz PB, Yazar EE, Gorgun D, Secik F, Cakir G
- Issue date: 2011
- Differential diagnosis between lymphoma-associated malignant pleural effusion and tuberculous pleural effusion.
- Authors: Kim CH, Oh HG, Lee SY, Lim JK, Lee YH, Seo H, Yoo SS, Lee SY, Cha SI, Park JY, Lee J
- Issue date: 2019 Aug
- A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion.
- Authors: Liu Y, Ou Q, Zheng J, Shen L, Zhang B, Weng X, Shao L, Gao Y, Zhang W
- Issue date: 2016 Aug 3
- Diagnostic utility of adenosine deaminase (ADA) activity in pleural fluid and serum of tuberculous and non-tuberculous respiratory disease patients.
- Authors: Lamsal M, Gautam N, Bhatta N, Majhi S, Baral N, Bhattacharya SK
- Issue date: 2007 Mar