Utility of medical thoracoscopy in patients with undiagnosed pleural effusion in chest department in beni-suef university

Abeer S.E. Mohamed, Neveen M Amin, Mahmoud El-Batanouny

Egyptian Journal of Bronchology 2017 11(3):276-282

Introduction Pleural diseases involve the parietal and visceral pleura and may be of either inflammatory or malignant origin, with pleural effusions. Medical thoracoscopy (MT) is a procedure involving internal examination and biopsy of masses within the pleural and thoracic cavity. It is a valuable tool that enables a wide variety of diagnostic and therapeutic procedures. Aim The aim of this work was to assess the role of MT in patients with exudative undiagnosed pleural effusion. Patients and methods A total of 42 patients with undiagnosed exudative pleural effusion were admitted to Chest Department, Faculty of Medicine, Beni-Suef University. They were subjected to written informed consent,full history, clinical examination, sputum analysis, chest radiography, chest computed tomography, ECG, routine liver and kidney functions tests, complete blood count, coagulation profile, viral markers, and Tuberculin test. Diagnostic thoracentesis was done. The pleural fluid was subjected to testing for sugar, protein, lactate dehydrogenase, adenosine deaminase, cytopathology, Gram’s stain, and acid-fast bacilli smear and culture. Patients in whom the pleural effusion remained undiagnosed were subjected to MT. Results This study was applied on 42 patients with inconclusive cytological results: 20 were malignant (nine malignant pleural mesothelioma and 11 metastases), five had tuberculous pleurisy, eight had empyema, and nine had nonspecific pleurisy. Regarding pleural fluid cytological analysis, five cases were positive for atypical mesothelial cells. Conclusion MT is a valuable tool in the diagnosis of undiagnosed exudative pleural effusion. It is simple and safe, with high diagnostic yield and lower complication rates.

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