Introduction: Medical thoracoscopy is a minimally invasive procedure, that allows complete visualization of the pleural space using a combination of viewing and working instruments and enables various diagnostic and therapeutic procedures, i.e. pleural biopsy, pleurodesis, etc.
Aims & Objective: Role of medical thoracoscopy in diagnosis of undiagnosed exudative pleural effusions.
Material & Methods: It is a prospective study conducted in Department of Pulmonary Medicine, SCB Medical College Cuttack, Odisha from January 2017 to July 2018. After detailed clinical evaluation, radiological investigations, pleural fluid analysis; medical thoracoscopy was donetaking all into account, with written informed consent on 123 consecutive cases of undiagnosed exudative pleural effusion .
Observation: Majority of cases (42.2%) were >60 years with male: female of 2.4:1. Hemorrhagic effusion accounted for 58.6%. ADA level was <40U/L in 109 (88.6%) cases and >40U/L in 14(11.4%) cases. Most common CT thorax finding was Lung mass in 28.5%, followed by pleural nodules in 16.3% of cases. Thoracoscopic findings were multiple pleural nodule(82%) followed by septations (35%) and hyperemia (16%). Malignancy was found in 61 cases (50%) followed by granulomatous lesion suggestive of tuberculosis in 19 cases (15.4%). Major histopathological cell type was adenocarcinoma (49.6%). Chest pain (20.3%) was most common complication followed by oxygen desaturation (8%) and parietal oedema (8%). Sensitivity and specificity of thoracoscopy in malignancy was 86% and 100% respectively and in tubercular pleural effusion was 89% and 97% respectively.
Conclusion: Medical thoracoscopy is a safe, simple, and valuable tool in the diagnosis of undiagnosed exudative pleural effusion with minimal complications.
Impact Factor
2022: 6.012
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