Endoscopic ultrasound-guided evaluation of undiagnosed pleural effusion

Abstract

Background and Objectives:Thoracocentesis is the first diagnostic procedure for pleural effusion (PE). If diagnosis after thoracocentesis remains uncertain pleural biopsy, either computed tomography/ultrasonography (CT/USG) guided or thoracoscopy is required for definitive diagnosis. We present the data about evaluation of undiagnosed PE by endoscopic ultrasound (EUS)-guided pleural aspiration or fine needle aspiration cytology (FNAC) of the lymph nodes/pleural deposits. This is the first case series regarding EUS-guided FNAC of the pleural deposits or nodules.Methods:Eleven patients of undiagnosed PE were evaluated by EUS. The CT/USG reports were reviewed before EUS. The PE aspiration was performed by EUS needle. The EUS-FNA of the mediastinal nodes or pleural deposits was done by a 22-gauge needle.Results:Seven patients had right-sided and four had left-sided PE. Three cases had unsuccessful attempts/complications at US-guided aspiration. A single pass was successful in diagnostic aspiration and the aspirated fluid was suggestive of tuberculosis (TB). The remaining eight cases had nondiagnostic aspiration, and FNAC with rapid on-site evaluation was done from mediastinal lymphadenopathy or pleural deposits. Four cases with mediastinal lymphadenopathy had granulomatous lesions. Four cases with pleural deposits had malignancy.Conclusions:EUS-guided imaging introduces a totally different path/technique of imaging for inspection of the pleural space. EUS-FNA can be performed as a safe procedure in undiagnosed PE. At present, it appears that EUS-guided evaluation is an alternative modality for evaluation of undiagnosed PE, in the cases who are unfit for thoracoscopy and as an alternative or adjunct to USG/CT-guided aspiration or biopsy. Further studies will be required to clarify its exact role in pleural diseases.