Retrospective study to evaluate the results of medical thoracoscopy in diagnosis of exudative pleural effusion at chest department El-Hussein university hospital in the period from July 2013 to July 2018

Abstract

Background: Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. It enables taking pleural biopsies under direct vision, therapeutic drainage of effusions, and pleurodesis in one sitting. Persistent and recurrent exudative pleural effusions become common and thoracocentesis and blind pleural biopsy procedures do not give a definitive diagnosis in many patients. Therefore, thoracoscopy today remains the gold standard for these cases. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%. Objective: This study was carried out to analyze our five years experience of medical thoracoscopy in the management of undiagnosed exudative pleural effusion at chest department El-Hussein University Hospital. Materials and Methods: All patients with undiagnosed exudative pleural effusion who underwent thoracoscopy during the period between July 2013 to July 2018 at Al Hussein University Hospital were included in the study. All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, pleural fluid analysis and medical thoracoscopy with multiple pleural biopsies. All patients data, thoracoscopy results and complications were recorded. Results: Thoracoscopy was successful for giving final diagnosis in 122 patients (84.13%) from total 145 patients. Malignancies reported in 113 patients (77.9%) of patients and TB reported in 6.2% of patients. Mesothelioma was the most common diagnosis in 67 patients(46.2%) Minor complications occurred only in 14 out of 145 patients (9.65%), 4 patients (2.8%) developed cellulitis, 8 patients (5.5%) developed surgical emphysema, and 2 patient (1.4%) developed bleeding. Conclusion: Medical thoracoscopy is an easy, safe procedure with high diagnostic sensitivity for pleural effusion of uncertain etiology.