Skip to main content

Utility of medical thoracoscopy in patients with undiagnosed pleural effusion in chest department in beni-suef university

Abstract

Introduction

Pleural diseases involve the parietal and visceral pleura and may be of either inflammatory or malignant origin, with pleural effusions. Medical thoracoscopy (MT) is a procedure involving internal examination and biopsy of masses within the pleural and thoracic cavity. It is a valuable tool that enables a wide variety of diagnostic and therapeutic procedures.

Aim

The aim of this work was to assess the role of MT in patients with exudative undiagnosed pleural effusion.

Patients and methods

A total of 42 patients with undiagnosed exudative pleural effusion were admitted to Chest Department, Faculty of Medicine, Beni-Suef University. They were subjected to written informed consent,full history, clinical examination, sputum analysis, chest radiography, chest computed tomography, ECG, routine liver and kidney functions tests, complete blood count, coagulation profile, viral markers, and Tuberculin test. Diagnostic thoracentesis was done. The pleural fluid was subjected to testing for sugar, protein, lactate dehydrogenase, adenosine deaminase, cytopathology, Gram’s stain, and acid-fast bacilli smear and culture. Patients in whom the pleural effusion remained undiagnosed were subjected to MT.

Results

This study was applied on 42 patients with inconclusive cytological results: 20 were malignant (nine malignant pleural mesothelioma and 11 metastases), five had tuberculous pleurisy, eight had empyema, and nine had nonspecific pleurisy. Regarding pleural fluid cytological analysis, five cases were positive for atypical mesothelial cells.

Conclusion

MT is a valuable tool in the diagnosis of undiagnosed exudative pleural effusion. It is simple and safe, with high diagnostic yield and lower complication rates.

References

  1. Blanc FX, Atassi K, Bignon J, Housset B. Diagnostic value of medical thoracoscopy in pleural disease: a 6-year retrospective study. Chest 2002; 121:1677–1683.

    Article  PubMed  Google Scholar 

  2. Loddenkemper R, Boutin C. ‘Thoracoscopy’ present diagnostic and therapeutic indications. Eur Respir J 1993; 6:1544–1555.

    CAS  PubMed  Google Scholar 

  3. Davies HE, Nicholson JE, Rahman NM, Wilkinson EM, Davies RJO, Lee YCG.Outcomeof patientswithnonspecific pleuritis/fibrosisonthoracoscopic pleural biopsies. Eur J Cardiothorac Surg 2010; 38:472–477.

  4. Metintas M, Dundar E, Ak G, Yildrim H, Ozkan R, Kurt E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest 2010; 137:1362–1368.

    Article  PubMed  Google Scholar 

  5. Froudarakis ME. Thoracoscopy one century later: the oldest interventional technique of modern pneumonology, with great future prospects. Pneumon 2010; 23:31–33.

    Google Scholar 

  6. Tassi GF, Davies RJO, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J 2006; 28:1051–1059.

    Article  CAS  PubMed  Google Scholar 

  7. Mathur PN, Loddenkemper R. Medical thoracoscopy: role in pleural and lung diseases. Clin Chest Med 1995; 16:487–496.

    CAS  PubMed  Google Scholar 

  8. Loddenkemper R, Lee P, Noppen M, Mathur PN. Medical thoracoscopy/ pleuroscopy: step by step. Breathe 2011; 8:157–167.

    Google Scholar 

  9. Porcel JM, Vives M. Etiology and pleural fluid characteristics of large and massive effusions. Chest 2003; 124:978–983.

    Article  PubMed  Google Scholar 

  10. Sahn SA. The differential diagnosis of pleural effusions. West J Med 1998; 137:99–108.

    Google Scholar 

  11. Loddenkemper R. Thoracoscopy – state of the art. Eur Respir J 1998; 11:213–221.

    Article  CAS  PubMed  Google Scholar 

  12. Feinsilver SH, Barrows AA, Braman SS. Fiberoptic bronchoscopy and pleural effusion of unknown origin. Chest 1986; 90:516–519.

    Article  CAS  PubMed  Google Scholar 

  13. Harris RJ, Kavuru MS, Rice TW, Kirby TJ. The diagnostic and therapeutic utility of thoracoscopy. A review. Chest 1995; 108:828–841.

    Article  CAS  PubMed  Google Scholar 

  14. Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJO, Downer NJ, et al. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65:ii54–ii60.

    PubMed  Google Scholar 

  15. Hooper C, Lee YC, Maskell N, BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65:ii4–ii17.

    Article  PubMed  Google Scholar 

  16. Mohamed S, Shaban M. Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion: one year prospective study. Egypt J Chest Dis Tuberc 2014; 63:897–905.

    Article  Google Scholar 

  17. Ahmed MA, Abdel Halim HA, Aziz ET, El-Shorbagy RM. Outcomes and complications of medical thoracoscopy in undiagnosed exudative pleural effusion. Egypt J Bronchol 2016; 10:93–99.

    Article  Google Scholar 

  18. Helala LA, El-Assal GM, Farghally AA, Abd El Rady MM. Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital. Egypt J Chest Dis Tuberc 2014; 63:629–634.

    Article  Google Scholar 

  19. Prabhu V, Narasimhan R. The role of pleuroscopy in undiagnosed exudative pleural effusion. Lung India 2012; 29:128–130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Guo ZJ, Lin Q, Liu HT, Lu JY, Zeng YH, Meng FJ, et al. The preliminary exploration of 64 slice volume computed tomography in the accurate measurement of pleural effusion. Acta Radiol 2013; 54: 765–769.

    Article  PubMed  Google Scholar 

  21. Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002; 346:1971–1977.

    Article  PubMed  Google Scholar 

  22. Mohan A, Chandra S, Agarwal D, Naik S, Munavvar M. Utility of semirigid thoracoscopy in the diagnosis of pleural effusions: a systematic review. J Bronchol Interv Pulmonol 2010; 17:195–201.

    Article  Google Scholar 

  23. Jiang SJ, Mu XY, Zhang S, Su LL, Ma WX. The diagnostic value of medical thoracoscopy for unexplained pleural effusion. Zhonghua Jie He He Hu Xi Za Zhi 2013; 36:337–340.

    PubMed  Google Scholar 

  24. Wang Z, Tong ZH, Li HJ, Wang C. Semi-rigid thoracoscopy for undiagnosed pleural effusion; a comparative study. Chin Med J 2008; 121:1384–1389.

    Article  PubMed  Google Scholar 

  25. Noppen M. Pleural biopsy and thoracoscopy. Eur Respir Mon 2010; 48:119–132.

    Google Scholar 

  26. Verma SK, Dubey AL, Singh PA, Tewerson SL, Sharma D. Adenosine deaminase level in tubercular pleural effusion. Lung India 2008; 25: 109–110.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Niwa Y, Kishimoto H, Shimokata K. Carcinomatous and tuberculous pleural effusion. Chest 1985; 87:351–355.

    Article  CAS  PubMed  Google Scholar 

  28. Diacon AH, van de Wal F BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tuberculosis pleurisy: a direct comparative study. Eur Respir J 2003; 22:589–591.

    Article  CAS  PubMed  Google Scholar 

  29. Koegelenberg CF, Diacon AH, Bolliger CT. Parapneumonic pleural effusion and empyema. Respiration 2008; 75:241–250.

    Article  PubMed  Google Scholar 

  30. Bilgin M, Akcali Y, Oguzkaya F. Benefits of early aggressive management of empyema thoracis. ANZ J Surg 2006; 76:120–122.

    Article  PubMed  Google Scholar 

  31. Ravaglia C, Gurioli C, Tomassetti S, Casoni GL, Romagnoli M, Gurioli C, et al. Is medical thoracoscopy efficient in the management of multiloculated and organized thoracic empyema? Respiration 2012; 84:219–224.

  32. Davies HE, Nicholson JE, Rahman NM, Wilkinson EM, Davies RJO, Lee YG. Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies. Eur J Cardiothorac Surg 2010; 38: 472–477.

    Article  PubMed  Google Scholar 

  33. Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003; 58:1–59.

    Google Scholar 

  34. Lee P, Colt H. Rigid and semi-rigid pleuroscopy: the future is bright. Respirology 2005; 10:418–425.

  35. Özgül MA, Çetinkaya E, Tanrıverdi E, Çörtük M, Acat M, Gül S, et al. Diagnostic value and safety of medical thoracoscopy in the management of exudative pleural effusion. Eurasian J Pulmonol 2016; 18: 139–142.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Abeer S. E. Mohamed MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohamed, A.S.E., Amin, N.M. & El-Batanouny, M. Utility of medical thoracoscopy in patients with undiagnosed pleural effusion in chest department in beni-suef university. Egypt J Bronchol 11, 276–282 (2017). https://doi.org/10.4103/ejb.ejb_87_16

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_87_16

Keywords