The prognostic significance of idiopathic pleural effusion.

The practicing physician, despite mass chest x-ray surveys and similar programs, must still remain the most important single factor in tuberculosis case finding. Early case finding and treatment are the major tenets of effective tuberculosis control, as they are in any communicable disease, and have been practiced most diligently in many areas. The presence of parenchymal pulmonary lesions by x-ray, symptomatology and bacteriologic study of the sputum or gastric expressions are frequently in themselves diagnostic of tuberculosis or prompt continued study and observation of the patient to evaluat the presumptive diagnosis. Unfortunately, however, the role of the so-called “idiopathic” pleural effusion as one of the important early manifestations of tuberculous infection is less readily recognized by many physicians and the opportunity for control of the tuberculous process in its minimal phase is not infrequently lost. The lack of positive diagnostic etiologic findings, either laboratory or x-ray, has undoubtedly In most instances contributed to this difficulty. It is the purpose of this paper to emphasize the basic importance of this entity as a clinical manifestation of active tuberculous Infection and the necessity for early treatment to avoid Its known and varied complications. Pleural effusions occur as complications in many diseases, chiefly the bacterial or viral pneumonitides, rheumatic fever, invasion of the pleura by neoplastic tissue or lymphoma, congestive heart failure, renal disease and tuberculosis. The differential diagnosis of the underlying disease in these instances and the characteristics of complicating pleural effusion have been described extensively in standard textbooks and the literature, and need not be elaborated here. The age of the patient, symptoms, bacteriologic studies, response to drug or antibiotic therapy will frequently substantiate or narrow the clinical impressions within a short time. It is the