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The diagnosis of TB in the absence of direct microbiological proof was based on a high clinical probability combined with radiological evidence (n=14), pleural fluid analysis alone (n=5), CSF analysis (n=7) or histological findings (n=1).
Typical findings of posteriorly layering pleural fluid include a subtle gradient of opacity in the lower chest, blunting of the lateral sulci, loss of a perceptible diaphragm, and loss of vascular marking below the diaphragm.
However, as routine hospital procedure, several hundred pleural fluid and CSF samples were sent to bacteriologists in Lisbon for further investigation (serotyping, PCR, some culture and susceptibility confirmation).
Analysis of pleural fluid aspirates should include the following: Basic * Stains for AFB, TB culture * Bacterial MCS * Cytology * Differential cell count * ADA * LDH * Protein Additional * Albumin * Glucose * IFN-[gamma] * Fungal culture * Lipid analysis * Haematocrit * Amylase * Tumour markers * Complement C4 level
Drainage of milky-white pleural fluid suggests chylothorax that can be confirmed by pleural fluid examination.
A diagnosis of interstitial pneumonia was made with an extensive ground glass appearance and bilateral pleural fluid (Picture 1) on thoracic computarized tomography (CT).
A sample of the pleural fluid had a total protein concentration of 38 g/L and a white blood cell count of 20.
Percutaneous drainage of the pleural fluid was helpful in excluding infection and malignancy, but not in establishing the diagnosis of underlying etiology.
A segment from parietal pleura was sent for culture and pleural fluid was also sent for culture and biochemical analysis.