Medical thoracoscopy – Diagnostics of pleural effusion with indefinite etiology

Abstract

Introduction: Pleural effusion occurs when extra fluid accumulates in the pleural space of the body. Pleural effusion is a symptom of underlying pathology caused by lung, pleural, and systemic diseases. In approximately 75% of patients, cytobiochemical and microbiological investigation of pleural fluid can provide an etiological diagnosis. Despite thoracentesis diagnostics and its concerned workup, the root cause remains unidentified. Despite primary tests, medical thorocoscopy plays an important role in undiagnosed pleural effusion. This study is planned in order to appraise as to what would be the diagnostic yield on implementing medical thoracoscopy in a tertiary care centre where patients were being treated for pleural effusion of unknown etiology. Methodology: From June 2021 to June 2022, Saveetha Medical College and Hospital in Thandalam, Kanchipuram, initiated a prospective, interventional, and non-randomised study. Our institution conducted a study on pleural effusion cases that were not diagnosed following the initial biochemical and cytological analysis of their respective pleural fluids. Results: This study included 53 patients with pleural effusion. 42 patients(79.25%) had definitive diagnosis and 11 patients(20.75%) had inconclusive histopathological report. It was noted that 30 (56.6%) patients with definitive diagnosis had cancer, 10 (18.9%) had tuberculosis, and 2 (3.8%) had empyema. In our investigation, the diagnostic yield on implementing medical thoracoscopy was 79.25%. The overall sensitivity in our study was 89.36%, with specificity at 100%, positive predictive assessment at 100%, and negative predictive assessment at 54.5%. Conclusion: Medical thoracoscopy is a minimally invasive, well-tolerated, and safe process that aids in the accurate identification of pleural effusion of unknown etiology. It also allows for the provision of therapeutic approaches such as pleurodesis and adhesiolysis. As a consequence, patients having pleural effusion in which the etiology is not known should opt for medical thoracoscopy.