Medical Thoracoscopy for Undiagnosed Exudative Pleural Effusion: A Descriptive Cross-sectional Study
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Abstract:
Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion.
Methods: This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean (±SD) and frequency (percentage).
Results: A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively.
Conclusions: Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.Keywords:
Thoracoscopy
Contraindication
Pleurisy
We present three cases of successful chemical pleurodesis with a liquid solution of mistletoe extract using a spray catheter during medical thoracoscopy. The medical thoracoscopy was performed in all presented cases to remove pleural effusion and conduct chemical pleurodesis to manage symptomatic malignant pleural effusion. A spray catheter was used to instil the mistletoe extract evenly into the pleural cavity, and there were no pleurodesis‐related complications. Respiratory symptoms caused by pleural effusion improved after pleurodesis, and successful pleurodesis was maintained for more than 3 months after medical thoracoscopy in all three patients.
Pleurodesis
Thoracoscopy
Thoracic cavity
Pleural cavity
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Objective To explore the superiority of thoracoscopy in diagnosing and treating malignant pleural effusion.Methods Pleural biopsy and immobilization were performed in 30 patients with malignant pleural effusion under thoracoscopy.Thorax puncture,closed Thoracic Drainage,thoracic injected with adhesive were performed in 28 patients with malignant pleural effusion.Results Comparison and analysis of two groups were carried out.Results Diagnosis rate of the group of thoracoscopy was 100%,the efficacy of treatment was 93.3%.At the same time diagnosis rate of the control group was 64%,the efficacy of treatment was 53.5%.Conclusion Thoracoscopy has satisfactory value for diagnosis of malignant pleural effusion and has little injury and short convalescent period.
Thoracoscopy
Thorax (insect anatomy)
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Thoracoscopy
Pleurodesis
Pleural disease
Pleurisy
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Objective To explore the superiority of thoracoscopy in diagnosing and treating malignant pleural effusion.Methods Pleural biopsy and immobilization were performed in 27 patients with malignant pleural effusion under thoracoscopy.Results The diagnoses of all the patients were determined.The pleural effusions of all the patients were controlled effectively.There were one postoperative re-expansive pulmonary edema and five recurrences.Conclusions Thoracoscopy has satisfactory value for diagnosis of malignant pleural effusion.The pleural immobilization with thoracoscopy has advantages of small wound and good efficacy.
Thoracoscopy
Expansive
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Pleural effusion in sarcoidosis is infrequent. The data on thoracoscopic observations of sarcoidosis pleurisy are limited. The present study describes three cases of sarcoid-related pleurisy diagnosed by medical thoracoscopy and discusses the thoracoscopic features of sarcoid pleuritis. The appearance of pleural nodules was completely different in the three cases, and the distribution of nodules of sarcoidosis was heterogenously located in the pleural surfaces. Pleural disease in sarcoidosis could be proved easily by sampling visible nodules, and pleural fluid could be aspirated without complications during thoracoscopy. Due to symptomatic pleurisy of sarcoidosis, therapy was given as systemic corticosteroid. In conclusion, thoracoscopy may be an appropriate alternative technique to obtain an accurate diagnosis in sarcoid pleurisy.
Thoracoscopy
Pleurisy
Pleural thickening
Pleural disease
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Thoracoscopy
Pleurisy
Pleural disease
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Medical thoracoscopy has been shown to be an efficacious procedure in diagnosing unexplained exudative pleural effusions with excellent safety. This study aimed to assess the diagnostic significance of thoracoscopy in the management of patients with malignant pleural effusion (MPE). Consecutive patients with malignant pleural effusion were retrospectively reviewed, and their demographic, radiographic, thoracoscopic and histological data were collected. Between July 2005 and June 2014, 342 of 833 patients undergoing thoracoscopy were finally confirmed to suffer from MPE. The top three frequent causes of MPE were metastatic carcinoma (79.5%), malignant mesothelioma (10.2%), and lymphoma (2.9%). Among metastatic malignancies, the most common cancer was lung cancer (85.2%), followed by breast cancer (4.4%), ovarian cancer (2.2%), pancreatic cancer (1.8%), etc. No serious adverse events associated with thoracoscopy were recorded. Medical thoracoscopy is a valuable and safe tool in diagnosing malignant pleural effusion with minimal complication rates.
Thoracoscopy
Metastatic carcinoma
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Objective To explore the effects of the clinical application of medical thoracoscopy in the diagnosis and treatment of malignant pleural effusion.Methods Patients with malignant pleural effusion were divided into the thoracoscopic group and the control group.The diagnostic positive rate and clinical curative effect were retrospectively observed and compared.Results The diagnostic rates were 92.9% and 69.05% respectively in the thoracoscopic group and in the control group.There were significant differences in complete remission rate and total efficiency between the two groups(P 0.05).Conclusion Medical thoracoscopy has a high positive diagnostic rate in the pleural biopsy of patients with malignant pleural effusion.Besides,pleurodesis under medical thoracoscopy can effectively control the generation of malignant pleural effusion,which is more effective than the conventional chest drainage and worth to be applied in clinical use widely.
Thoracoscopy
Pleurodesis
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Objective To summarize the clinical features and manifestations under thoracoscopy of 41 elderly patients with tubercular pleurisy,and to discuss the importance of medical thoracoscopy for the diagnosis of tubercular pleurisy in the elderly. Methods The clinical features and manifestations under thoracoscopy of 41 patients with tubercular pleurisy in the elderly diagnosed by flexible electron-assisted thoracoscopy and biopsy were retrospectively analyzed. Results The clinical presentations of tubercular pleurisy were atypical in the elderly.Cough(75.6%) and chest tightness and dyspnea(87.8%) were the most common,and the coexistence proportion of both disease(85.4%) and misdiagnosis rate(68.3%) were high.Based on observation of thoracoscopy there were small punctual sarcoidosis(41.5%),one or more sarcoidosis(26.8%),pleural congestion and edema(19.5%) and pleural thickening and fibrinous adhesion(12.2%) in 41 elderly patients.Distribution of the focus lesion was as follows: 46.3% on parietal pleura with posterior,12.2% on anterior,7.3% on lateral,7.3% on diaphragmatic pleura,19.5% diffusively distributed and 7.3% on visceral pleura.There was no serious complication. Conclusions The clinical profiles of tubercular pleurisy are nonspecific in the elderly.To make a definite diagnosis,medical thoracoscopic surgery should be carried out as early as possible.
Thoracoscopy
Pleurisy
Parietal Pleura
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