Medical thoracoscopy- an experience

Abstract

Background: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases especially undiagnosed exudative pleural effusion. It is cost effective and safe. The diagnostic yield in undiagnosed pleural effusion is excellent.Methods: This prospective observational study was done in Government Chest Disease hospital of Government Medical College, Srinagar during the period between December 2015 to Dec 2016.Thirty undiagnosed pleural effusion patients after thoracocentesis and who fulfilled inclusion and exclusion criteria’s were included in the study. Medical thoracoscopy using rigid thoracoscope was started for the first time in our hospital and was done in these enrolled patients. Clinical, Thoracoscopic findings and histopathological data of the patients were collected prospectively and analysed.Results: Maximum patients were in the age group of 41-50 years. Most common Thoracoscopic finding was multiple nodules (40%) followed by sago grain infiltration (33.4%). Malignancy was the most common HPE finding of pleural biopsy (46.6%) followed by TB (33.3%). All nodules (13) turned out to be malignant while all sago grain appearance pleura (10) turned out of to be TB. The overall diagnostic yield is 80% as a whole and 96% among patients who had thoracoscopic pleural findings.Conclusions: Medical Thoracoscopy is a safe and easy outpatient procedure and an excellent diagnostic tool for undiagnosed exudative pleural effusion. The diagnostic yield is quite high and complications of procedure are negligible.

Scope of medical rigid thoracoscopy in patients with pleural effusion of unknown etiology: A prospective single center study

“…We also found plural thickening in a few. These findings were in concordance with Helala et al, 21 Shah et al, 14 and Prabhu and Narasimhan 22 studies. On correlation of physical finding with clinical diagnosis we found that the most common diagnosis with sago grain appearance of pleura was TB as in Helala et al, 21 Shah et al, 14 and Mishra et al 20 This was found to be statistically significant(P=0.012).…”

“…These findings were in concordance with Helala et al, 21 Shah et al, 14 and Prabhu and Narasimhan 22 studies. On correlation of physical finding with clinical diagnosis we found that the most common diagnosis with sago grain appearance of pleura was TB as in Helala et al, 21 Shah et al, 14 and Mishra et al 20 This was found to be statistically significant(P=0.012). Whereas most common diagnostic finding of nodular appearance of pleura was malignancy which was in concordance with studies conducted by Helala et al, 21 Prabhu and Narasimhan, 22 and Mishra et al 20 This association was not found to be statistically significant.…”

“…Lee et al, 17 Our results showed that the most common nature of pleural fluid was straw colored followed by hemorrhagic, yellow colored, and milky. This was in concordance with Mishra et al, 20 and was different from what was seen in Shaheen et al, 18 Huo et al, 19 and Shah et al 14 The probable reason for the similarity with above mentioned study was found to be the fact that TB patients formed the major subset in this study as well like in ours where pleural fluid being straw colored is expected. The studies with hemorrhagic effusions predominantly had malignancy as the diagnosis from medical thoracoscopy like in Shaheen et al, 18 and Shah et al, 14 Huo et al, 19 had yellow colored pleural fluid with TB.…”

“…Fisher Z-test for Binomial Proportion Sample size calculated = 31 14 A total of 31 cases of undiagnosed pleural effusion after thoracocentesis were enrolled in the study after fulfilling inclusion criteria and taking written informed consent.…”

Diagnostic accuracy of semirigid thoracoscopy in exudative pleural effusions and relationship of thoracoscopic findings with probability of malignant diagnosis

“…Various studies across the globe have reported similar diagnostic yield (4,(11)(12)(13)(14)(15)(16). Studies from Indian subcontinent reported diagnostic yield ranging from 66% to 97% (17)(18)(19)(20)(21)(22). Some of the studies included non-specific pleuritis as a final diagnosis that has increased their diagnostic yield (23)(24)(25).…”