Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions.
BACKGROUND
Medical thoracoscopy is a minimally invasive procedure used in diagnostic and therapeutic applications for pleural diseases. In this study, we describe our experience in the outcome and analysis of thoracoscopy in undiagnosed pleural effusion presenting to our center.


METHODS
This is a prospective study conducted over last 2 years. We performed thoracoscopy in 129 cases of undiagnosed exudative pleural effusions using rigid thoracoscope. Clinical, radiological, cyto and histopathological data of the patients were collected prospectively and analyzed.


RESULTS
The overall diagnostic yield of thoracoscopic pleural biopsy was 110/129 (85.2%) in patients with undiagnosed pleural effusion, and 19/129 (14.8%) patients remained unexplained. Histopathological diagnosis confirmed malignancy in 66.4% patients (both primary and metastatic pleural carcinoma), tuberculosis in 28.2%, others including parapneumonic effusion in 4 cases followed by multiple myeloma, lupus pleuritis, and pulmonary langerhans cell histiocytosis in one case each. Procedure-related mortality was nil. Minor complications related to the procedure include hemorrhage, subcutaneous emphysema, etc.


CONCLUSIONS
Thoracoscopy is relatively a safe and well-tolerated procedure with high diagnostic accuracy in undiagnosed pleural effusions, decreasing the need of formal diagnostic thoracotomy. Every chest physician must, therefore, consider this procedure to decrease the time lag in achieving the final diagnosis and to initiate the treatment as early as possible.
Department of Pathology, J.L.N. Medical College, Ajmer, Rajasthan, India.
Chetan Basavaraj
CB
Patil
Department of Respiratory Medicine, J.L.N. Medical College, Ajmer, Rajasthan, India.
Ramakant
R
Dixit
Department of Respiratory Medicine, J.L.N. Medical College, Ajmer, Rajasthan, India.
Rakesh
R
Gupta
Department of Respiratory Medicine, J.L.N. Medical College, Ajmer, Rajasthan, India.
Neeraj
N
Gupta
Department of Pathology, J.L.N. Medical College, Ajmer, Rajasthan, India.
Varna
V
Indushekar
Pleural biopsy; pleural effusion; rigid thoracoscope