Medical thoracoscopy in evaluation of undiagnosed pleural effusion

Abstract

Background:Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion. Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia. Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed. Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%. Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates.

A Study of Role of Medical Thoracoscopy in Undiagnosed Pleural Effusion

“…In our study, the majority of the patients (37.5%) were found to be in the age group of 61-70 years which is comparable with study of Swarnakar et al, 3 Brims et al, 4 Ahmad Dar et al 5 All the patients who were enrolled in this study had breathlessness and cough which is comparable with the study of Soe et al, 6 Prabhu and Narasimhan, 7 and Patil et al 8 in which breathlessness is the most common presenting symptom in 86.3%, 75.4%, and 67.4% patients, respectively followed by cough in 86.3%, 67.3%, and 53.4% patients, respectively.…”

VATS (Video Assisted Thoracoscopic Surgery) Pleural Biopsy in the Diagnosis of Unexplained Pleural Effusion

“…Among the 75 patients, 36% (27) patients have different co-morbidities. Similar results were seen in a study done by Nattusamy L et al 26 Minimum morbidity & mortality in that study were due to less percentage of associated co morbidities in the study population as there is direct association between co morbidities with morbidity & mortality. 26 Similar observations were found in our research.…”

“…Similar results were seen in a study done by Nattusamy L et al 26 Minimum morbidity & mortality in that study were due to less percentage of associated co morbidities in the study population as there is direct association between co morbidities with morbidity & mortality. 26 Similar observations were found in our research. However any co relation between associated co morbidities and complications of VATS pleural biopsy was not done in our study.…”

“…13 In another study done by Dar KA et al described that the gross thoracoscopic visual findings were multiple variable-sized nodules in 67 (53.6%) patient, followed by sago granular appearance in 19 (15.2%) patients, adhesions in 14 (11.2%) patients, mass lesion in 9 (7.2%) patients, diffuse pleural thickening in 6 (4.8%) patients, apparently healthy smooth pleura in 2 (1.6%) patients. 26 These data correlated with our data.…”

“…In a study by Dar KA et al metastatic adenocarcinoma was the most common malignancy (50%) followed by mesothelioma (36.84%), squamous cell carcinoma (9.21%), small cell carcinoma (2.63%), and non-Hodgkin's lymphoma (1.31%). 26 In an article, Jamal U A.et al found metastatic adenocarcinoma was the most frequent type (70%) of the malignant case for unexplained effusion. 18 Those results were similar to our study.…”