Abstract
Objective: When pleuritis or empyema does not respond to chest tube drainage and antibiotics, a surgical approach is needed. Tuberculous pleuritis is known to be related to high adenosine deaminase (ADA) levels in the pleural fluid. Our purpose was to evaluate the effect of surgery for pleuritis and empyema, and the relation of the ADA levels. Methods: We examined a series of 17 patients with empyema or pleuritis (empyema, n=10; pleuritis, n=7 including tuberculous pleuritis, n=4) who underwent surgery and were followed-up for six months retrospectively. We scored chest Xp findings to assess lung expansion as follows. Score 2: the CP angle is clearly observed. Score 1: the CP angle is dull but the diaphragm is clearly obsereved. Score 0: neither the CP angle nor diaphragm is clearly observed. We scored the chest Xp at preoperation, and the day after and, one week after, one month after, and six months after the operation. Respectively, we also assessed the adenosine deaminase (ADA) levels in pleuritis and empyema and compared the scores of chest Xp. Results: In the empyema group, postoperative lung expansion proceeded extremely well inspite of ADA levels. In the pleuritis group, low ADA levels (<40 IU/L) indicated a more favorable improvement. Conclusion: Scoring of chest Xp findings for pleuritis and empyema after surgery is useful to assess the effect of the operation objectively.
