- Pleural diseases
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Ultrasound-assisted medical thoracoscopy
Egyptian Journal of Bronchology volume 9, pages 92–95 (2015)
Abstract
Introduction
Medical thoracoscopy is an important tool for the diagnosis and management of several pleural diseases. The presence of fibrous pleural adhesions may prevent medical thoracoscopy to access the pleural space properly, which may lower the diagnostic yield of the procedure and may also increase the risk for associated complications. The role of on-table chest ultrasound (US) before medical thoracoscopy is investigated in this study.
Aim of the study
The aim of this study was to evaluate the utility of on-table chest US before medical thoracoscopy and its ability to locate a safe point of entry, its impact on the facility of the procedure, and the risk for complications.
Patients and methods
Forty patients who underwent medical thoracoscopy for investigation of undiagnosed pleural effusion were included in this study. They were randomized into two groups. In group I, chest US was performed on table immediately before medical thoracoscopy and in group II, no chest US was performed.
Results
Computed tomography chest detected pleural adhesions in one patient (5%) in group I and in two patients (10%) in group II, whereas medical thoracoscopy detected five patients (25%) in group II and six patients (30%) in group I. Chest US was able to detect all cases with pleural adhesions in group I. Four patients (20%) in group II needed extra procedures to access the pleural cavity due to unsuccessful primary point of entry, and two (10%) had complications in the form of bleeding. All patients in group I had successful access to the pleural cavity with no needed extra procedures and no complications. The mean duration of the procedure in group I was 42 ± 5.4 versus 50 ± 10.4 min in group II.
Conclusion
Chest US performed before medical thoracoscopy can facilitate the procedure; it reduces the unsuccessful attempts to access the pleural cavity, minimizes the risk for complications, and reduces the duration of the procedure.
References
Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J 2006; 28:409–422.
Mathur P, Martin WJ II. Clinical utility of thoracoscopy. Chest 1992; 102: 2–4.
Tassi GF, Davies RJ, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J 2006; 28:1051–1059.
Hersh CP, Feller-Kopman D, Wahidi M, Garland R, Herth F, Ernst A. Ultrasound guidance for medical thoracoscopy: a novel approach. Respiration 2003; 70:299–301.
Grogan DR, Irwin RS, Channick R, Raptopoulos V, Curley FJ, Bartter T, Corwin RW Complications associated with thoracentesis. A prospective, randomized study comparing three different methods. Arch Intern Med 1990; 150:873–877.
Xirouchaki N, Georgopoulos D. The use of lung ultrasound: a brief review for critical care physicians and pneumonologists. Pneumon 2007; 20: 134–141.
Kocijancic I, Kocijancic K, Cufer T. Imaging of pleural fluid in healthy individuals. Clin Radiol 2004; 59:826–829.
Kearney SE, Davies CW, Davies RJ, Gleeson FV. Computed tomography and ultrasound in parapneumonic effusions and empyema. Clin Radiol 2000; 55:542–547.
Chian CF, Su WL, Soh LH, Yan HC, Perng WC, Wu CP. Echogenic swirling pattern as a predictor of malignant pleural effusions in patients with malignancies. Chest 2004; 126:129–134.
Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003; 58(Suppl 2):ii8–ii17.
Medford AR, Agrawal S, Bennett JA, Free CM, Entwisle JJ. Thoracic ultrasound prior to medical thoracoscopy improves pleural access and predicts fibrous septation. Respirology 2010; 15:804–808.
Macha HN, Reichle G, von Zwehl D, Kemmer HP, Bas R, Morgan JA The role of ultrasound assisted thoracoscopy in the diagnosis of pleural disease. Clinical experience in 687 cases. Eur J Cardiothorac Surg 1993; 7:19–22.
Wang Z, Tong ZH, Li HJ et al. Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study. Chin Med J 2008; 121:1384–1389.
Wilsher ML, Veale AG. Medical thoracoscopy in the diagnosis of unexplained pleural effusion. Respirology 1998; 3:77–80.
Fletcher SV, Clark RJ. The Portsmouth thoracoscopy experience, an evaluation of service by retrospective case note analysis. Respir Med 2007; 101:1021–1025.
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Shoukri, A. Ultrasound-assisted medical thoracoscopy. Egypt J Bronchol 9, 92–95 (2015). https://doi.org/10.4103/1687-8426.153660
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DOI: https://doi.org/10.4103/1687-8426.153660