To study the diagnostic yield of pleuroscopy in undiagnosed

Background and objectives: Pleuroscopy is a minimally invasive procedure useful in patients with undiagnosed exudative pleural effusion. The objective of the present study is to evaluate the role of pleuroscopy in undiagnosed pleural effusions.
Methods: This was a prospective observational study conducted at the Department of Respiratory Medicine, Sunshine Hospitals, Hyderabad. The Study period was for 1 year from December 2018 to November 2019.
Results: A total of 34 patients underwent Pleuroscopy for Undiagnosed exudative pleural
effusions. The age group of the patients ranged from 15-84 years and the mean age was 55.2 years. Males were 26 (76.7%) and 8(23.5%) were females. Majority of patients were Non-smokers 58.82% (20/34). 22 patients (64.7%) were found to have Right sided pleural effusion and 12(35.2%) patients showed effusion on left side. On gross examination of pleural fluid, 18(52.94%) patients had Hemorrhagic effusion, 16(47.06%) patients had straw coloured effusion. Majority of the patients had Pleural effusion with Mediastinal shift 22(64.7%) on imaging, Pleuraleffusion with Mediastinal Lymphadenopathy in 3(8.8%) patients, Pleural effusion with Pleural Nodular enhancement seen in 5(14.7%) patients and 4(11.7%) patients had miscellaneous finding of which 3 patients had Hydro-Pneumothorax and 1 patient with Right sided effusion with left upper lobe Nodular lesion. On Pleuroscopic examination, Multiple variable Pleural Nodules were seen in 15(44.12%) patients, Fibrinous adhesions were seen in 7(20.59%) patients, Sago grain nodules in 9(26.47%) patients, Hyperemic pleura in 1(2.94%) patient, Pleural plaques were noted in 1(2.94%) patient and Mass lesions over parietal pleura noted in 1(2.94%) patents. On Pleuroscopic tissue biopsy for GeneXpert
MTB/Rif, MTB was not detected in GeneXpert in 28(82.35%) patients, MTB detected and
Rif Resistance detected in 1(2.94%) patient and MTB was detected and Rif Resistance was not
detected in 5(14.7%) with low MTB detection in 2(5.88%) and medium MTB detection in
3(8.82%) patients. Thoracoscopic Pleural biopsy on Histopathological examination
revealed an overall diagnostic yield of 88.24%. We were able to diagnose 30 of 34 patients
of whom 16 (47.05%) patients were diagnosed as Pulmonary Adenocarcinoma, 10 patients (29.41%) showed Granulomatous inflammation consistent with Tuberculosis, 3(8.82%) patients showed chronic inflammation, 1(2.94%) patient (with past history of Left Carcinoma Breast) showed metastatic deposits and 4(11.76%) patients had no definitive diagnosis (Inconclusive), The overall diagnostic yield of Pleuroscopy conducted at our center was 88.24% (30/34 patients).
Conclusion: Pleuroscopyhas a good diagnostic yield in patients with undiagnosed exudative pleural effusions and is a safe procedure as well.