Asunto(s)
Enfermedades del Mediastino/diagnóstico , Tuberculosis Ganglionar/diagnóstico , Parálisis de los Pliegues Vocales/diagnóstico , Anciano , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Ronquera/etiología , Humanos , Enfermedades del Mediastino/complicaciones , Enfermedades del Mediastino/diagnóstico por imagen , Enfermedades del Mediastino/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/diagnóstico por imagen , Tuberculosis Ganglionar/tratamiento farmacológico , Parálisis de los Pliegues Vocales/complicaciones , Parálisis de los Pliegues Vocales/diagnóstico por imagenRESUMEN
BACKGROUND: Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed pleural effusion. Literature on its utility from developing countries is limited. We herein describe our initial experience on the utility of semi-rigid thoracoscopy from a tertiary care teaching and referral center in north India. We also perform a systematic review of studies reporting the utility of semi-rigid thoracoscopy from India. PATIENTS AND METHODS: The primary objective was to evaluate the diagnostic utility of semi-rigid thoracoscopy in patients with undiagnosed exudative pleural effusion. Semi-rigid thoracoscopy was performed under local anesthesia and conscious sedation in the bronchoscopy suite. RESULTS: A total of 48 patients underwent semi-rigid thoracoscopy between August 2012 and December 2013 for undiagnosed pleural effusion. Mean age was 50.9 ± 14.1 years (range: 17-78 years). Pre-procedure clinico-radiological diagnoses were malignant pleural effusion [36 patients (75%)], tuberculosis (TB) [10 (20.83%) patients], and empyema [2 patients (4.17%)]. Patients with empyema underwent the procedure for pleural biopsy, optimal placement of intercostal tube and adhesiolysis. Thoracoscopic pleural biopsy diagnosed pleural malignancy in 30 (62.5%) patients and TB in 2 (4.17%) patients. Fourteen (29.17%) patients were diagnosed with non-specific pleuritis and normal pleura was diagnosed on a pleural biopsy in 2 (4.17%) patients. Overall, a definitive diagnosis of either pleural malignancy or TB was obtained in 32 (66.7%) patients. Combined overall sensitivity, specificity, positive predictive value and negative predictive value of thoracoscopic pleural biopsy for malignant pleural effusion were 96.77%, 100%, 100% and 66.67%, respectively. There was no procedure-related mortality. On performing a systematic review of literature, four studies on semi-rigid thoracoscopy from India were identified. CONCLUSION: Semi-rigid thoracoscopy is a safe and efficacious procedure in patients with undiagnosed exudative pleural effusions.
Asunto(s)
Neumonía en Organización Criptogénica/complicaciones , Tuberculosis Pulmonar/complicaciones , Adulto , Neumonía en Organización Criptogénica/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Radiografía Torácica , Esputo/microbiología , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/microbiologíaAsunto(s)
Embolia Pulmonar/diagnóstico por imagen , Infarto Pulmonar/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Enfermedad Aguda , Angiografía , Femenino , Humanos , Pierna/diagnóstico por imagen , Embolia Pulmonar/complicaciones , Infarto Pulmonar/complicaciones , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler , Trombosis de la Vena/complicaciones , Adulto JovenRESUMEN
Tracheobronchopathia osteochondroplastica is a rare benign airway disorder which is characterised by submucosal nodules projecting into the tracheo-bronchial lumen usually involving the cartilaginous portions of the tracheo-bronchial tree or larynx. The condition is usually asymptomatic but can rarely present with difficulty during endotracheal intubation or rarely with obstructive airway complications. Bronchoscopic appearance is usually sufficient to make the diagnosis, and tissue biopsies are seldom required. No specific treatment is required in asymptomatic patients. However, interventional bronchoscopy procedures or surgery may be helpful in symptomatic cases.