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VOLUME 12 , ISSUE 2 ( April-June, 2023 ) > List of Articles

Original Article

The Outcome of Medical Thoracoscopy in Patients with Unexplained Exudative Pleural Effusion

Sharath Chandra KS, Chandramouli M Thimmaiah, Giridhar B Hosmane

Keywords : Malignancy, Nodules, Pleural effusion, Rigid thoracoscopy, Tuberculosis

Citation Information : KS SC, Thimmaiah CM, Hosmane GB. The Outcome of Medical Thoracoscopy in Patients with Unexplained Exudative Pleural Effusion. Indian J Respir Care 2023; 12 (2):109-112.

DOI: 10.5005/jp-journals-11010-1031

License: CC BY-NC-SA 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Exudative pleural effusion of unknown etiology is a diagnostic perplexity. Medical thoracoscopy (MT) is a less invasive procedure and has a high diagnostic utility in these patients. Objectives: The study goal was to analyze the value of MT in patients with exudative pleural effusion of unknown cause. Materials and methods: The cross-sectional observational study included clinical data of patients with unexplained pleural effusion of exudative type who had undergone MT at a tertiary care center between July 2019 and June 2022. Results: The diagnostic MT was performed on 28 patients with exudative pleural effusion, which diagnostic thoracentesis could not explain. The diagnostic yield was 96.42%. The mean age was 52.9 ± 13.5 (range 25–75) years, and 17 (60.7%) were males. Malignancy was diagnosed in 60.70% (17/28) of patients, tuberculosis in 28.60% (8/28) of patients, and nonspecific pleuritis/fibrosis in 10.70% (3/28) of patients. Out of 17 patients with malignancy, metastatic adenocarcinoma was detected in 70.58% (12/17) of patients, malignant mesothelioma in 17.64% (3/17) of patients, and poorly differentiated in 11.76 % (2/17) of patients. No major complications were observed and only three patients had minor complications. Conclusion: Medical thoracoscopy (MT) is a minimally invasive, risk-free, and effective tool for the diagnosis of unexplained exudative pleural effusion with added therapeutic advantages with high diagnostic yield and minimal complication rate.

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  1. Narasimhan RL, Sehgal IS, Dhooria S, et al. Removal of intrapleural foreign body by medical thoracoscopy: report of two cases and a systematic review of the literature. J Bronchology Interv Pulmonol 2017;24(3):244–249. DOI: 10.1097/LBR.0000000000000275
  2. Rozman A, Camlek L, Marc-Malovrh M, et al. Rigid versus semi-rigid thoracoscopy for the diagnosis of pleural disease: a randomized pilot study. Respirology 2013;18(4):704–710. DOI: 10.1111/resp.12066
  3. Light RW. The undiagnosed pleural effusion. Clin Chest Med 2006;27(2):309–319. DOI: 10.1016/j.ccm.2005.12.002
  4. Munavvar M, Khan MA, Edwards J, et al. The autoclavable semirigid thoracoscope: the way forward in pleural disease? Eur Respir J 2007;29(3):571–574. DOI: 10.1183/09031936.00101706
  5. Wang Z, Tong ZH, Li HJ, et al. Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study. Chin Med J (Engl) 2008;121(15):1384–1389. DOI: 10.1097/00029330-200808010-00010
  6. Dhooria S, Singh N, Aggarwal AN, et al. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir Care 2014;59(5):756–764. DOI: 10.4187/respcare.02738.
  7. Mohamed SA, Shaban MM. Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion: one year prospective study. Egypt J Chest Dis Tuberc 2014;63(4):897–905. DOI: 10.1016/j.ejcdt.2014.06.007
  8. Prabhu VG, Narasimhan R. The role of pleuroscopy in undiagnosed exudative pleural effusion. Lung India 2012;29(2):128–130. DOI: 10.4103/0970-2113.95304.
  9. Helala LA, El-Assal GM, Farghally AA, et al. Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital. Egypt J Chest Dis Tuberc 2014;63(3):629–634. DOI: 10.1016/j.ejcdt.2014.04.002
  10. Patil CB, Dixit R, Gupta R, et al. Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions. Lung India 2016;33(5):502–506. DOI: 10.4103/0970-2113.188969
  11. Hansen M, Faurschou P, Clementsen P. Medical thoracoscopy, results and complications in 146 patients: a retrospective study. Respir Med 1998;92(2):228–232. DOI: 10.1016/s0954-6111(98)90100-7
  12. Valsecchi A, Arondi S, Marchetti G. Medical thoracoscopy: analysis on diagnostic yield through 30 years of experience. Ann Thorac Med 2016;11(3):177–182. DOI: 10.4103/1817-1737.185755
  13. Ahmed MM, Abdel Halim HA, Aziz ET, et al. Outcomes and complications of medical thoracoscopy in undiagnosed exudative pleural effusion. Egypt J Bronchol 2016;10(2):93–99. DOI: 10.4103/1687-8426.184367
  14. Hui M, Uppin SG, Bhaskar K, et al. Malignant mesothelioma: a histomorphological and immunohistochemical study of 24 cases from a tertiary care hospital in Southern India. Indian J Cancer 2018;55(2):190–195. DOI: 10.4103/ijc.IJC_584_17
  15. Mootha VK, Agarwal R, Singh N, et al. Medical thoracoscopy for undiagnosed pleural effusions: experience from a tertiary care hospital in north India. Indian J Chest Dis Allied Sci 2011;53(1):21–24. DOI: 10.5005/ijcdas-53-1-21
  16. Sud R, Mujeeb VR, Tilak T, et al. The diagnostic dilemma of an exudative pleural effusion and the emerging role of thoracoscopic pleural biopsy in these patients: a study from South India. Ann Med Res Pract 2022;3:2. DOI: 10.25259/ANMRP_24_2021
  17. Kiani A, Abedini A, Karimi M, et al. Diagnostic yield of medical thoracoscopy in undiagnosed pleural effusion. Tanaffos 2015;14(4):227–231. PMID: 27114723
  18. Shrestha BK, Adhikari S, Thakur BK, et al. Medical thoracoscopy for undiagnosed exudative pleural effusion: experience from two tertiary care hospitals of Nepal. JNMA J Nepal Med Assoc 2020;58(223):158–164. DOI: 10.31729/jnma.4873
  19. Rahman NM, Ali NJ, Brown G, et al. British Thoracic Society pleural disease guideline group. Local anaesthetic thoracoscopy: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65(2):54–60. DOI: 10.1136/thx.2010.137018
  20. Nour Moursi Ahmed S, Saka H, Mohammadien HA, et al. Safety and complications of medical thoracoscopy. Adv Med 2016;2016:3794791. DOI: 10.1155/2016/3794791
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