Egyptian Journal of Chest Disease and Tuberculosis (Jan 2017)
Six years experience of medical thoracoscopy at Al Hussein University Hospital
Abstract
Background: Pleural effusion, pneumothorax, and pleural thickening are frequently encountered in pulmonary practice. Although the radiographic detection of pleural abnormalities may be obvious, determination of a specific diagnosis can present a challenge. Computed axial tomographic (CT) and ultrasound scans of the thorax and bronchoscopy with transbronchial biopsies may be helpful in selected circumstances, but the diagnostic yield for pleural disease is disappointingly low. Thoracoscopy (or pleuroscopy) involves passage of an endoscope through the chest wall and offers the clinician a “window” for direct visualization and collection of samples from the pleura. It is a valuable diagnostic procedure and, in some cases, can also provide an opportunity for treatment. Aim of the study: This study was carried out to analyze our six years experience of medical thoracoscopy in the management of undiagnosed pleural effusion at Al Hussein University Hospital. Methods: The study conducted on 170 patients with undiagnosed pleural effusion, 100 males and 70 females with age ranging between 22 and 85 (mean age 56 ± 12.48). The thoracoscopic findings of the pleura were nodules in 109 patients (64.12%), adhesions in 32 patients (18.82%), masses in 7 patients (4.12%), collections of pus in 3 patients (1.76%), foreign body (central veinous line in 1 patient (0.59%) and nonspecific findings in 18 (10.59%). In this study thoracoscopy was successful for giving final diagnosis in 161 patients (94.7%) from total 170 patients. Results: The thoracoscopic findings of the pleura were nodules in 109 patients (64.12%), adhesions in 32 patients (18.82%), masses in 7 patients (4.12%), collections of pus in 3 patients (1.76%), foreign body (central veinous line in 1 patient (0.59%) and nonspecific findings in 18 (10.59%). Thoracoscopy was successful for giving final diagnosis in 161 patients (94.7%) from total 170 patients. malignancies reported in 83.53% of patients, benign lesions reported in 11.18% of patients, non specific pleurisy in 9 patients (5.29%) TB in 16 patients (9.41%) and empyema in 3 patients (1.77%). The most common pathological malignant type was malignant pleural mesothelioma in 84 patients (49.41%) followed by adenocarcinoma in 44 patients (25.88%), squamous cell carcinoma in 2 patients (1.18%), small cell carcinoma 1 patient (0.59%), malignant melanoma in 1 patient (0.59%) and thymoma in 1 patient (0.59%).we found no post-thoracoscopic complications in 159 out of 170 patients (93.52%), whereas minor complications occurred only in 11 out of 170 patients (6.48%); 5/170 patients (2.94%) developed surgical emphysema, 3/170 patients (1.77%) developed empyema, and 3/170 patient (1.77%) developed air leak. Conclusion: Medical thoracoscopy is an easy procedure and an excellent diagnostic procedure for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of procedures for management of pleural effusion.
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