Correspondence

Case 8-2002: Pleural Effusion

N Engl J Med 2002; 347:147July 11, 2002

Article

To the Editor:

In her discussion of Case 8-2002 (March 14 issue),1 Dr. Quinn includes hypothyroidism in the differential diagnosis of exudative pleural effusions. Hypothyroidism usually causes transudative pleural effusions.2 Furthermore, the patient had a low level of thyrotropin with normal levels of triiodothyronine and free thyroxine, indicating the presence of subclinical hyperthyroidism rather than hypothyroidism.

Nitin Trivedi, M.D.
Joel Popkin, M.D.
Saint Vincent Hospital at Worcester Medical Center, Worcester, MA 01608
ntrivedi@massmed.org

2 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 8-2002). N Engl J Med 2002;346:843-850
   Full Text | Web of Science | Medline

2. 2

   Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's principles of internal medicine. 15th ed. New York: McGraw-Hill, 2001:1515.
   

To the Editor:

Dr. Quinn provides an instructive discussion of a patient with a persistent pleural effusion but does not mention the usefulness of information on adenosine deaminase levels in the diagnosis of tuberculous pleurisy.1

It is surprising that the diagnosis of tuberculous pleural effusion was ruled out on the basis of the computed tomographic (CT) findings. We would never rule out pleural tuberculosis on the basis of CT findings without measuring adenosine deaminase levels or performing a closed pleural biopsy.

David Jiménez, M.D.
Gema Díaz, M.D.
Esteban Pérez-Rodríguez, M.D.
Hospital Ramón y Cajal, 28034 Madrid, Spain
djc_69_98@yahoo.com

1 References

1. 1

   Perez-Rodriguez E, Jimenez Castro D. The use of adenosine deaminase and adenosine deaminase isoenzymes in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med 2000;6:259-266
   CrossRef | Medline