pleural effusion

1. A Study of Role of Medical Thoracoscopy in Undiagnosed
Pleural Effusion
BY DR TAHEER KHAN
DR SACHITHANANDAM/ DR MANASWINI DARBA
MODERATOR : DR SESHASAYANA

2. AIM & OBJECTIVE
• To know the diagnostic yield of pleuroscopy (medical thoracoscopy) in cases of pleural effusions
which remain undiagnosed after routine initial investigations.
• To notice the different gross pleuroscopic findings during the procedure.
• To observe various histopathological reports of pleural biopsy taken through medical
thoracoscopy.
• To know the various complications of pleuroscopy in patients undergoing this procedure.

3. MATERIALS AND METHODS
• A total of 56 patients having undiagnosed pleural effusion were taken
for study after informed written consent. All patients underwent
medical thoracoscopy.
• The clinical,demographic, and radiological profile of patients was
recorded.
• Gross pleuroscopic findings and histopathological reports of the
pleural biopsy were noted.
• All patients were observed for any complications that occurred during
or after the procedure.

4. DIAGNOSIS
• Out of 56 patients, 51 (91.07%) were diagnosed by medical thoracoscopy.
• The yield of thoracoscopy in this study is 91.07%.
• 1. A total of 42 (75%) patients were diagnosed with malignancy among which
adenocarcinoma in 34 (60.71%) patients, three (5.35%) patients with
mesothelioma, and three (5.35%) small cell carcinoma.One (1.78%) male
diagnosed with squamous cell and one (1.78%) carcinoma and papillary cell
carcinoma.
• 2. Seven (12.5%) patients were diagnosed as tuberculous pleuritis followed by
two (3.57%) patients who had an acute inflammatory pleural reaction.
• 3. Five (8.92%) pat ient s remained undiagnosed even after the thoracoscopic
procedure and pleural biopsy.

5. • STUDY DESIGN : prospective study
• STUDY DURATION : 1 year
• PLACE : tertiary care hospital, AhmedabadInclusion criteria :
1. All the cases of undiagnosed pleural effusion even af ter all routine investigations, microbiological, and biochemical
testing of pleural fluid after thoracentesis and willing to go for thoracoscopy.
2. Hemodynamicaly stable.
Exclusion criteria :
• Patient is not willing for thoracoscopy.
• Patients who are unfit for thoracoscopy.
• Patients with multiloculated effusion.
• Patients in whom pleural space is likely to
be inaccessible easily.
• Patients with honeycomb lung, suspected
hydatid cyst, pulmonary arteriovenous
aneurysms, and highly vascularized
pulmonary lesions.
• Patients with hemodynamic unstability.

6. RESULTS
• Diagnostic yield of thoracoscopy in the present study was 91.07%
(malignant pleural effusion 75% and tuberculous pleuritis 12.5%).
• Adenocarcinoma was the commonest malignancy in 60.71% of
patients amongst malignant pleural effusion in the present study.
Very few complications were recorded.
• The most common postprocedure complication was subcutaneous
emphysema (12.5%) followed by pneumothorax (10.78%).

7. • LIMITATIONS :
• This is a cross sectional study and hence, follow-up of patients is not done.
• The patient population is largely limited to western India and hence, further multicentre studies are
required to asses the generalizability of our results.
• Non-availability of fibro scan.
• CONCLUSION:
• Thoracoscopy provides a positive diagnosis of pleural effusions in whom the
diagnosis has not been achieved by initial investigations, and repeated cytological
and biochemical analysis of pleural fluid.
• The major advantage of thoracoscopy is that it gives an opportunity to perform a
biopsy on suspicious-looking pleural lesions and nodules on the surface of the lung
under direct vision.
• It is also possible to break down the adhesions with biopsy forceps.
• In addition, it is possible to carry out chemical pleurodesis at the same time.
• This procedure has the advantages of visual inspection, high safety, and few
complications.
• The diagnostic yield of thoracoscopy is higher in undiagnosed pleural effusions so
this procedure should be carried out in all undiagnosed pleural effusions whenever
feasible.