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.