Thoracoscopy and its Role in Evaluating Undiagnosed Pleural Effusions

ABSTRACT

Introduction: Definition of undiagnosed pleural effusion was considered as the failure to achieve an etiologic diagnosis byinitial pleural fluid microbiological, biochemical analysis, and at least three pleural fluid cytologies negative for malignant cells orother definite causes. Medical thoracoscopy also referred to as pleuroscopy is an endoscopic evaluation of the pleural space.Thoracoscopy was mainly used in the etiological diagnosis of pleural effusions and therapeutic procedures such as pleurodesisand adhesiolysis. In around 20%–30% of cases, etiology remains unclear and in this context, thoracoscopy becomes animportant investigation modality.Materials and Methods: It is a prospective, interventional study taken up as a pilot project by the Department of PulmonaryMedicine of SVS Medical College and Hospital, Mahabubnagar, Telangana, India. A total of 30 patients were satisfyingthe inclusion criteria and were further studied for their thoracoscopic and histopathological findings from January 2018 toNovember 2018.Results: A total of 30 patients out of whom 19 patients were male (63.3%) and 11 patients (36.6%) were female. The mostcommon respiratory symptom was shortness of breath in 18 patients (60%) and cough in 12 patients (40%). Out of the total30 cases, 23 (76.66%) were malignant and 7 (23.33%) were diagnosed to be having tuberculosis (benign). According to thehistopathological diagnosis, 20 (66.6%) had metastatic adenocarcinoma, 7 (23.3%) had tuberculosis and malignant lymphoma,and metastatic squamous cell carcinoma and sarcoma were detected in 1 (3.3%) patient. According to thoracoscopic findings,13 (43.3%) patients had mass lesion, 12 (40%) patients had nodule, 3 (6.6%) patients had adhesions, and 2 (10%) patientshad plaques. Majority of the mass lesions 11 (36.66%) were metastatic adenocarcinomas and majority of nodules 5 (16.66%)were diagnosed as tuberculous lesions.