Medical Thoracoscopy: Diagnostic Role in the Management of Undiagnosed Pleural Effusions and its Complications

Introduction: Cases of undiagnosed exudative pleural effusions are common in clinical practice and pose a diagnostic challenge for pulmonologists. Medical thoracoscopy allows both direct visualizations of pleural space for diagnostic evaluation and chemical pleurodesis for therapeutic purposes. Objectives: This study investigated the diagnostic role of medical thoracoscopy in the cases of undiagnosed exudative pleural effusions and complications of thoracoscopic pleural biopsy. Patients and methods: Between December 2016 and August 2019, 195 patients of undiagnosed exudative pleural effusions underwent medical thoracoscopy in our institute. Pleural biopsies were taken and sent for histopathological and microbiological examination. Results: The diagnostic yield of medical thoracoscopy in this study was 89.7%. Definite diagnosis was achieved in 175 out of 195 patients of the study population and only 20 (10.3%) patients were failed to be diagnosed by medical thoracoscopy. Histopathological results of thoracoscopic pleural biopsy among the study population revealed tubercular pleuritis in 31.79% (62 patients), metastatic adenocarcinoma in 23.07% (45 patients), malignant mesothelioma in 18.46% (36 patients), parapneumonic effusions in 6.66% (13 patients), metastatic squamous cell carcinoma in 5.64% (11 patients), small cell carcinoma in 3.07% (6 patients), malignant lymphoma in 0.51% (1 patient), and rheumatoid pleuritis in 0.51% (1 patient). Only 19.4% (38 patients) had minor complications like pain, minor bleeding, subcutaneous emphysema, and re-expansion pulmonary edema. Conclusion: Thoracoscopy is a safe, well-tolerated procedure with minimal risk allowing the accurate diagnosis of undiagnosed pleural effusion. Besides determining the underlying cause, it also provides unique therapeutic approaches like pleurodesis to patients with malignant pleural effusions.

Utility of medical thoracoscopy in diagnosis and treatment of hemothorax due to carcinoma: A case report

Hemothorax cannot always be treated by thoracic surgeon. Rapidly improved interventional pulmonology broadens the application of medical thoracoscopy. We attempt to share our experiences of medical thoracoscopy for hemothorax and discuss the value of medical thoracoscopy in pleural diseases. We reported a 76-year-old male with hemothorax who was cured by medical thoracoscopy under local anesthesia together with argon plasma coagulation. Moreover, final pathological diagnosis was acquired as pleural sarcomatoid carcinoma. The unusual manifestation under medical thoracoscopy of such a relative rare disease was also described in this paper. The medical thoracoscopy could be used successfully for hemothorax instead of treating with surgeon, especially for those who cannot tolerate procedure of operation or surgical thoracoscopy

Medical thoracoscopy in evaluation of undiagnosed pleural effusion

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia.  Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates.

Diagnostic value of thoracoscopy routine pleural biopsy combined with frozen biopsy for pleural effusion / 中国内镜杂志

Objective To investigate the diagnostic value and safety of thoracoscopy routine pleural biopsy combined with frozen biopsy for pleural effusion. Methods A retrospective analysis was made on the pathological diagnosis rate of pleural effusion. Results 120 cases in thoracoscopy, 103 cases were confirmed with routine biopsy specimens (85.8%), 16 cases found in the lesions with conventional clamp not satisfactory tissue specimens, combined with frozen cut obtained satisfactory specimens, the diagnostic accuracy rate of 16 cases of cryobiopsy was 100.0%, and the total diagnostic accuracy rate of medical thoracoscopy combined with pleural biopsy and cryobiopsy was 95.0%. There was significant difference between conventional biopsy and cryobiopsy (P < 0.05). Conclusion Medical thoracoscopy combined with pleural biopsy and cryobiopsy can achieve a higher rate of pathological diagnosis, and the complications are mild, so it is worthy of clinical promoting.

Clinic Evaluation of Medical Thoracoscopy in the Diagnosis of 180 Cases of Pleural Sffusions / 昆明医科大学学报

Objective To evaluate the clinical value of medical thoracoscopy in the diagnosis of exudative pleural effusions with unknown etiology.Methods We analyzed retrospectively the clinical data of 180 patients with undiagnosed pleural effusions who underwent medical thoracoscopy and appraised clinical value regarding validity,effectivity and applicability of thoracoscopy.Result In 180 cases of pleural effusion,there were 178 cases of patients with a clear diagnosis,including 87 cases of tuberculous pleurisy,28 cases of malignant tumor,malignant breast bildes mesothelioma in 2,lung cancer in 24,bile duct carcinoma in 1,cercival cancer in 1),pneumonia 58 case fo pyothorax,5 caseso of pyothorax,and 2 cases withou clear diagnosis.No check failure and terminate,the 95％CI was 5 cases of 97.78％-99.98％.Conclusions Medical thoracoscopy is a safe and effective method in the diagnosis of exudative pleural effusions with unknown aetiology.The early application of this method is very helpful for the management of the pleural diseases in suitable patients.

Combined detection of pleural biopsy under medical thoracoscopy and serum tumor markers in diagnosis of pleural effusion with unknown reason / 中国内镜杂志

Objective To discuss combined detection of pleural biopsy under medical thoracoscopy and pulmonary serum tumor markers in diagnosis of pleural effusion with unknown reason.Methods 76 patients with pleural effusion caused by unknown reason from January 2014 to March 2016 were retrospectively analyzed. Pleural biopsy was conducted under medical thoracoscopy and sent for pathological examination, and 10 ml venous blood was collected from these patients upon admission for testing serum tumor markers (CEA, SCC-AG, ProGRP and CYFRA21-1).Results Among the 76 patients, there were 32 cases with benign lesions (14 with pulmonary tuberculosis, 9 with inlfammatory lesions, 6 with granulomatous inlfammation, 2 with empyema and 1 with hamartoma) and 44 cases with malignant lesions (18 with adenocarcinoma, 13 with squamous carcinoma, 6 with small cell lung cancer, 3 with adeno-squamous carcinoma, 2 with mesothelioma, 1 with large cell carcinoma and 1 with thymoma). The detection of serum tumor markers showed statistically significant differences in the levels of CEA, SCC-AG, ProGRP and CYFRA21-1 in serum between the malignant pleural effusion group and benign pleural effusion group (P = 0.021,P = 0.006,P = 0.003 andP = 0.010). The levels of various serum tumor markers in the malignant pleural effusion group were obviously higher than those in the benign pleural effusion group. According to the pathological results, patients with pleural effusions not caused by lung cancer (2 with mesothelioma and 1 with thymoma) were eliminated from 44 patients with malignant pleural effusions. The rest 41 patients with pleural effusions caused by lung cancer were divided into non-small cell lung cancer and small cell lung cancer according to the pathological types. The results showed that there were statistically signiifcant differences in the levels of CEA, ProGRP and CYFRA21-1 between non-small cell lung cancer and small cell lung cancer (P = 0.036,P = 0.005 andP = 0.008), while there was no statistically signiifcant difference in the level of SCC-AG (P = 0.811).Conclusions Due to high detection rate and high accuracy in detecting pleural effusions caused by unknown reason, medical thoracoscopy is of great signiifcance, especially for the diagnosis of malignant pleural effusions of pleural metastases. However, serum indicators may provide important reference values for us before the pathological results are available. Thus, it is an important means of diagnosing malignant pleural effusions caused by lung cancer and should be promoted in clinic.

Medical thoracoscopy: a retrospective analysis in a tertiary care centre

Medical thoracoscopy is a minimally invasive procedure to visualize the entire pleural surface and perform limited diagnostic and therapeutic procedures. One of the main indications for medical thoracoscopy is to obtain a diagnosis in an exudative pleural effusion when other, simpler methods non-diagnostic. Medical thoracoscopy can also be used for therapeutic procedures. The present study is an effort to analyse our experience of medical thoracoscopy in patient of undiagnosed pleural effusion. Methods: 25 patients of pleural effusion in which diagnosis was not made by routine pleural fluid examination (biochemical/microbiological/cytological evaluation) were subjected to video thoracoscopy and biopsy, pleural fluid taken for pathological examination and therapeutic interventions such as adhesiolysis and pleurodesis were done. Intercostal drain kept. Results: Overall yield in the present study is 92% (23 out of 25). Majority of patients had malignant effusions (19 patients - 76%), of which 8 had metastatic adenocarcinoma and 7 had malignant mesothelioma. 2 patients (8%) were diagnosed to have tuberculous pleurisy. Present study had no incidence of thoracoscopic complications. Conclusions: We recommend that thoracoscopy shall be the Investigation of choice of undiagnosed pleural effusion as it has good yield with minimal complications.

Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion

<p><b>INTRODUCTION</b>This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion.</p><p><b>METHODS</b>We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013.</p><p><b>RESULTS</b>Among the 41 patients, 36 underwent MT with the intent of biopsy and talc pleurodesis, 2 underwent MT for pleurodesis only and 3 had failed MT. Aetiologies of pleural effusion included lung cancer (n = 14), tuberculosis (n = 9), breast cancer (n = 7), ovarian cancer (n = 2), malignant mesothelioma (n = 1), congestive cardiac failure (n = 1), peritoneal dialysis (n = 1) and hepatic hydrothorax (n = 1); pleural effusion was undiagnosed in five patients. The overall diagnostic yield of MT, and the yield in tubercular and malignant pleural effusions were 77.8%, 100.0% and 82.6%, respectively; it was inconclusive in 22.2%. Complications that occurred were self-limiting, with no procedure-related mortality. The 30-day mortality rate was 17.1%. A total of 15 patients underwent TTP. The 30-, 60- and 90-day success rates were 77.8%, 80.0% and 80.0%, respectively, with one patient having complications (i.e. empyema). The 30-day mortality was 40.0%.</p><p><b>CONCLUSION</b>MT is a safe procedure with high diagnostic yields in undiagnosed pleural effusions. TTP is an effective method to stop recurrence of pleural effusions.</p>

The evaluate of Paraelectronic effusion by medical thoracoscopy / 中国医师进修杂志

Objective To determine chest ultrasound locating treatment of paraelectronic effusion by medical thoracoscopy.Methods We chose 40 Xinxiang center hospital patients in respiratory wards from June 2012 to June 2014,who was randomly divided into two teams,one was electron-assisted Thoracoscopic surgery,the other was thoracic cavity closed drainage combination of intrapleural injection of urokinase.It was 3rd reviewed by chest ultrasound,we evaluated curative effection ac cording to the drainage effect,we statisticsed two draining days and total inpatient days,and total hospital costs.The results two teams were compared between gender,age,nutritional status,effusion volume (length x width x depth),pleural effusion conventional,biochemical,lactate dehydrogenase,adenosine deaminase,carcinoembryonic antigen,the difference was not statistically significant (P ＞ 0.05).Pleural fluid culture results were negative.Medical thoracoscopy treatment group hospitalization days,drainage time was significantly shorter than the thoracic drainage combined with pleural urokinase group,The same was the cost of hospitalization.Medical thoracoscopy poor drainage treatment group was significantly lower than the thoracic drainage combined with pleural urokinase group (P ＜ 0.05).Conclusion To the middle-large number encapsulated paraelectronic effusion,chest ultrasound locating treatment by medical thoracoscopy early can reduce the formation of empyema,reduce the formation of pleural fiberboard.It is a safe,effective and worthy of promotion treatment.

Medical Thoracoscopy: A Useful Diagnostic Tool for Undiagnosed Pleural effusion.

Objective. We aimed to assess the role of medical thoracoscopy in patients with undiagnosed pleural effusion. Methods. Patiens presenting with pleural effusion underwent three pleural aspirations. Patients in whom pleural fluid analysis was inconclusive underwent closed pleural biopsy for diagnostic confirmation. Patients in whom closed pleural biopsy was incolcusive underwent medical thoracoscopy using a rigid thoracoscope with a viewing angle of zero degrees was done under local anaesthesia and sedation with the patient lying in lateral decubitus position with the affected side up. Biopsy specimens from parietal pleura were obtained under direct vision and were sent for histopathological examination. Results. Of the 128 patients with pleural effusion who were studied, pleural fluid examination established the diagnosis in 81 (malignancy 33, tuberculosis 33, pyogenic 14 and fungal 1); 47 patients underwent closed pleural biopsy and a diagnosis was made in 28 patients (malignancy 24, tuberculosis 4). The remaining 19 patients underwent medical thoracoscopy and pleural biopsy and the aetiological diagnosis could be confirmed in 13 of the 19 patients (69%) (adenocarcinoma 10, poorly differentiated carcinoma 2 and mesothelioma 1). Conclusion. Medical thoracoscopy is a useful tool for the diagnosis of pleural diseases. The procedure is safe with minimal complications.

Diagnostic Accuracy and Safety of Medical Thoracoscopy / 결핵및호흡기질환

BACKGROUND: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. METHODS: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. RESULTS: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). CONCLUSIONS: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.

Application of flexible t medical horacoscopy in the diagnosis of pleural effusion / 中国实用内科杂志

Objective To evaluate the application of flexible thoracoscopy in the diagnosis of pleural effusion.Methods Thoracoscopy was performed in 20 pleural effusion patients in our hospital from May to December 2007.Biopsies were performed in 16 patients,not in the other 4 patients since difinite diagnosis had been reached before thoracoscopy.Results Rate of accurate diagnosis via thoracoscopy was 93.75%(15/16).Results Of biopsy were as follows:adenocarcinoma 8 cases,squamous carcinoma 1 case,adenosquamous carcinoma 1 case,malignant pleural effusion 1 case,tuberculous pleuritis 4 cases,malignant mesothelioma 3 cases,chronic suppurative pleuritis 1 case,failed diagnosis 1 case.Presentations of lesions under thoracoscope were as follows:diffused miliary nodules 10 cases(10/20),multiple mass 7 cases(7/20),fibrous compartmentation or conglutination 9 cases(9/20).There were no severe complications.Conclusion Flexible medical thoracoscopy is a safe and efficient method of etiologic diagnosis of pleural effusion.