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.
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.
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
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
Light RW. The undiagnosed pleural effusion. Clin Chest Med 2006;27(2):309–319. DOI: 10.1016/j.ccm.2005.12.002
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
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
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.
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
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.
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
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
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
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
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
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
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
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
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
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
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
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