Is surgery necessary for tuberculosis post-pleural effusion?

Question

Hello doctor,

I have been detected with tuberculosis after pleural effusion. It has been a month. I have been taking the tuberculosis (TB) medicine, but my X-ray is still not clear. I am being suggested that the pleural layer may need a surgery to be taken out and would not get dissolved with medication. I also have some pain in ribs in the front of the left chest.

Answer 1

Hi,

Welcome to icliniq.com. Tuberculosis of the pleura is a common entity. In your case, it seems diagnosis must have been confirmed by thoracocentesis or a pleural tap and that fluid must have been sent for investigations. I would like to see those reports also. Pleural effusion needs to be drained early in the course of the disease if large else can cause pleural fibrosis. Pleural effusion itself can be a cause of pricky pain on inspiration and pleural fibrosis can cause continuous dull aching or pricky pain that if does not settle, may need surgery. The second thing that will require surgery is if the effusion is loculated or has multiple loculations or loculi containing pus. You should get an ultrasound thorax done which can tell if there is any residual effusion or not. If there is no effusion and still you have severe on going pain that means pleural fibrosis for which surgery is indicated. For now take ATT (anti-tubercular therapy), full course without gaps. Kindly upload pleural fluid and ultrasonography (USG) thorax reports so that I can guide you further.