الفهرس 
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Abstract
SUMMERY
The purpose of this study was to evaluate the incidence of tuberculous pleurisy diagnosed with medical thoracoscopy in patients with exudative effusion and low adenosine deaminase level. A cross sectional study was conducted on 85 patients with exudative pleural effusion with ADA level below 40 IU/L.
All patients subjected to the following:
Full history taken.
Clinical examination
Laboratory examination including: -
liver function tests
kidney function tests
CBC
ESR
Sputum analysis for AFB
TST ( Tuberculin in skin test )
Chest X – rays ,CT chest
Thoracocentesis for;
Protein-glucose-LDH- - Adenosine Deaminase (ADA)
Pleural fluid smear for AFB, Total and Differential cell counts, pH, culture and sensitivity.
Cytological examination for malignant cells.
8- Medical Thoracoscopy for inspections of pleural cavity and taking biopsies from parietal pleural.
We classified the patients as regarding the diagnosis based on thoracoscopic biopsy into two groups;
group (A): TB group (41 cases)
group (B): non-TB group (44 cases); (23/44) mesothelioma, (11/44) adenocarcinoma and (10/44). (nonspecific pleuritis)
This study revealed the following results:
The mean age of the studied patients was (40.34±15.89) years, 60% of them was males.
The most common complain of patients were dyspnea and cough (76.5% and 74.1%) respectively, followed by chest pain (44.7) %, toxic symptoms (35.3) % and expectoration (31.8) %, the less common presentation was haemoptysis (8.2) %.
The mean level of ADA in pleural effusion (23.2±9.9) IU/L
Thoracoscopic finding: (23/85) patients had thickened both pleurae with simple adhesion, (23/85) patients had thickened both pleurae and multiple variable size nodules, (15/85) had thickened parietal pleurae with tiny and small nodules, (13/85) had apparently health pleura with hyperaemia areas and (11/85) had multiple large nodules up to masses.
The mean age in TB group about (29±10.7) years while in non TB group about (50.9±12.3) years with significant statistical difference, p value=0.0001.
No significant association of sex, clinical presentation with any groups.
A significant statistical difference between the two groups as regarding; TLC and TST present, p value = (0.008 and 0.0001) respectively, while no significant statistical difference as regarding PLT, Create, AST and ALT, p value = (0.6, 0.9, 0.3 and 0.1) respectively.
Significant statistical difference between the two groups as regarding ADA level in effusion, p value = 0.009.
Significant association of pleural thickening with simple adhesion and thickened with tiny and small nodules with TB pleural effusion, while the other picture most commonly associated with nontuberculous pleural effusion, p value= 0.0001.
Cut off point level of ADA in effusion (28.7) IU/L, equal and above this level the sensitivity was 73.1%, specificity was 100%, PPV was 100%, NPV was 80% and accuracy of this test was 87%.