A low-cost method of managing pleural effusions

Introduction Pleural effusions have always been a challenge to manage. In India, lymphocyte-dominant exudative pleural effusions are usually empirically treated as tubercular, largely because medical pleuroscopy is unavailable; diagnosis of malignant pleural effusions can be delayed. We discuss a cost effective way of managing pleural effusions using a fibreoptic bronchoscope (FOB). Objectives 1) To demonstrate that pleuroscopy can be done successfully with a FOB through an intercostal drain (ICD). Materials and methods Eleven consecutive patients with undiagnosed pleural effusions, have undergone FOB pleuroscopy. In the FOB suite, under local anaesthesia and sedation, an intercostal chest drain (ICD) no 32 was introduced into the intercostal space. The FOB was inserted through the ICD and the entire parietal pleura, lung surface and diaphragm were visualised. Multiple parietal pleural biopsies were taken. Where malignancy was confirmed, the same procedure was repeated for pleurodesis. Results Among six patients showing a hyperaemic, nodular pleura, and 2 with an apparently normal pleural surface, histopathology showed adenocarcinoma. 6 of these 8 later underwent pleurodesis. In 3 patients with a nodular pleura, the biopsy showed caseating tuberculous granulomas. One patient developed re-expansion pulmonary edema; there were no mortality due to the procedure. The overall diagnostic yield was 91.9 %. Conclusions FOB can be used for pleural biopsy and pleurodesis instead of a semi-rigid pleuroscope. There are previous reports of this technique, but this is the first report from India. In resource-limited settings we can adapt low cost, available technology to new uses.