Pleuroscopy early experience in the exudative pleural effusion of unknown etiology

2021 ◽  
Vol 17 ◽  
Author(s):  
Atefeh Fakharian ◽  
Hamidreza Jabbardarjani ◽  
Mohamad Reza Masjedi ◽  
Masoud Shamaei
Keyword(s):  
Pleural Effusion ◽  
Previous History ◽  
Invasive Procedure ◽  
Therapeutic Interventions ◽  
Unknown Etiology ◽  
Safe Procedure ◽  
Pathologic Diagnosis ◽  
Medical Thoracoscopy ◽  
History Of ◽  
Exudative Pleural Effusion

Background: Pleuroscopy (medical thoracoscopy) is a minimally invasive procedure to inspect and perform a biopsy of the pleural space as well as to perform therapeutic interventions; pleural fluid drainage and pleurodesis. Material and Methods: In a retrospective study in Kasra Hospital, Tehran-Iran, the patients with exudative pleural effusion of unknown etiology who underwent pleuroscopy, were evaluated. These patients had negative smear and culture for infective agents. Also, the cytological review was negative for malignancy. Results: 62 patients had undergone pleuroscopy, of which 29 (46.7) were men. After the final evaluation, 47 patients (75.8%) had a definite pathologic diagnosis, of which 39 (82.9%) were cancer. Through these 39 cases, 18 cases (46.1%) had a history of the previously confirmed cancer, in which pleural pathology was consistent with the initial diagnosis. In 21 cases (53.9%), metastatic cancers were detected without a previous history. From a total of 47 cases with definite pathologic diagnosis, 8 cases (17%) had histopathologic evidence of granulomatous lesions consistent with tuberculosis and 15 patients (24%) showed non-specific inflammatory lesions. There was no morbidity and mortality among these patients. Discussion: Considering that pleuroscopy is a safe procedure with high diagnostic accuracy, malignancy is the most finding in the exudative pleural effusion of unknown etiology. This increases the importance of this procedure in these cases to prevent wasting the time and smear-negative anti-TB treatment.

scholarly journals Comparison of diagnostic yield and complications of bronchoscopy, closed pleural biopsy and medical thoracoscopic pleural biopsies in undiagnosed pleural effusions

2017 ◽  
Vol 5 (2) ◽  
pp. 388
Author(s):  
Kizhakkepeedika Davis Rennis ◽  
Jaboy Bibin ◽  
Vadakkan Thomas ◽  
Easwaramangalath Venugopal Krishnakumar
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Safe Procedure ◽  
Pleural Effusions ◽  
Pleural Biopsy ◽  
Predictive Values ◽  
Medical Thoracoscopy ◽  
Sensitivity Specificity ◽  
Blunt Trocar ◽  
Exudative Pleural Effusion

Background: Undiagnosed exudative pleural effusion is a commonly encountered clinical scenario, which requires further evaluation. This study was aimed to analyze the diagnostic yield and complications of three procedures- Bronchoscopy, closed (Abram’s) pleural biopsy and medical thoracoscopy. Further, this study assessed whether combining closed pleural biopsy with bronchoscopy can be a substitute for medical thoracoscopy.Methods: An observational study was conducted among people with undiagnosed exudative pleural effusion. Initially, closed pleural biopsies were performed with Abrams needle and multiple tissue fragments were taken through the incision and the samples were sent in formalin to the laboratory for histopathology examination. For thoracoscopy, a cannula of 10 mm diameter with blunt trocar was inserted into the pleural cavity and semi rigid thoracoscope was introduced through the trocar. Bronchoscopy was performed 48 hours after thoracoscopy. Sensitivity, specificity and positive and negative predictive values were calculated and compared.Results: Out of 25 people, 14 were diagnosed to have malignancy and 7 were diagnosed tuberculosis. The overall sensitivity of the three procedures were 28.5% for closed pleural biopsy, 14.2% for bronchoscopy, 95.2% for medical thoracoscopy, 42.8% for the combined pleural biopsy and bronchoscopy. The complication rate was lowest for bronchoscopy (4%), followed by medical thoracoscopy (8%) and closed pleural biopsy (16%).Conclusions: Medical thoracoscopy is a comparatively safe procedure which has got the highest sensitivity for the diagnosis of undiagnosed exudative pleural effusions. Bronchoscopy combined with closed pleural biopsy, the diagnostic yield was increased (than that of individual yield), but cannot be a substitute for medical thoracoscopy.

scholarly journals Medical thoracoscopy- an experience

2017 ◽  
Vol 5 (5) ◽  
pp. 2176
Author(s):  
Naveed Nazir Shah ◽  
Nazia Mehfooz ◽  
Syed Suraya Farooq ◽  
Khurshid A. Dar ◽  
. Shumayl ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Invasive Procedure ◽  
Cost Effective ◽  
Pleural Diseases ◽  
Medical College ◽  
Medical Thoracoscopy ◽  
Chest Disease ◽  
Disease Hospital ◽  
Exudative Pleural Effusion

Background: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases especially undiagnosed exudative pleural effusion. It is cost effective and safe. The diagnostic yield in undiagnosed pleural effusion is excellent.Methods: This prospective observational study was done in Government Chest Disease hospital of Government Medical College, Srinagar during the period between December 2015 to Dec 2016.Thirty undiagnosed pleural effusion patients after thoracocentesis and who fulfilled inclusion and exclusion criteria’s were included in the study. Medical thoracoscopy using rigid thoracoscope was started for the first time in our hospital and was done in these enrolled patients. Clinical, Thoracoscopic findings and histopathological data of the patients were collected prospectively and analysed.Results: Maximum patients were in the age group of 41-50 years. Most common Thoracoscopic finding was multiple nodules (40%) followed by sago grain infiltration (33.4%). Malignancy was the most common HPE finding of pleural biopsy (46.6%) followed by TB (33.3%). All nodules (13) turned out to be malignant while all sago grain appearance pleura (10) turned out of to be TB. The overall diagnostic yield is 80% as a whole and 96% among patients who had thoracoscopic pleural findings.Conclusions: Medical Thoracoscopy is a safe and easy outpatient procedure and an excellent diagnostic tool for undiagnosed exudative pleural effusion. The diagnostic yield is quite high and complications of procedure are negligible.

Cardiology

2018 ◽  
pp. 258-261
Author(s):  
Janey Phelps
Keyword(s):  
Transesophageal Echocardiography ◽  
Previous History ◽  
Pediatric Anesthesia ◽  
Invasive Procedure ◽  
Patient Characteristics ◽  
The United States ◽  
Good Choice ◽  
Risk Patients ◽  
History Of ◽  
Intranasal Midazolam

Congenital heart disease is the most common type of birth defect and is estimated to affect nearly 1% of all births per year in the United States. Echocardiograms are necessary to fully evaluate these defects, and depending on the age of the child, sedation may be required to ensure optimal imaging. This chapter discusses the sedation/anesthesia options for transthoracic echocardiography, transesophageal echocardiography, and cardioversion. For all of these procedures high-risk patients should be triaged to a pediatric anesthesia provider and in some cases, a pediatric cardiac anesthesiologist. Transthoracic echocardiograms can be completed with distraction and/or minimal sedation with oral or intranasal midazolam. If moderate sedation is required due to patient characteristics or previous history of failure with minimal sedation, intranasal dexmedetomidine is a good option. Transesophageal echocardiography is an invasive procedure; patients <2 years of age should be intubated and those >2 years of age can maintain a native airway with deep sedation with propofol. The need for cardioversion is infrequent in pediatrics but when needed, propofol is a good choice.

scholarly journals Medical Thoracoscopy for the Management of Exudative Pleural Effusion: A Retrospective Study

2020 ◽  
Vol Volume 13 ◽  
pp. 2845-2855
Author(s):  
Ling Gong ◽  
Guichuan Huang ◽  
Yi Huang ◽  
Daishun Liu ◽  
Xiaoping Tang
Keyword(s):  
Retrospective Study ◽  
Pleural Effusion ◽  
Medical Thoracoscopy ◽  
Exudative Pleural Effusion

scholarly journals Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural Effusion- A Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India

2020 ◽  
Author(s):  
Mohammad Arif ◽  
Rakesh Bhargava ◽  
Mohammad Shameem ◽  
Nafees Ahmad Khan ◽  
Sadaf Sultana
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Histopathological Examination ◽  
Diagnostic Yield ◽  
Uttar Pradesh ◽  
P Value ◽  
Fisher Exact Test ◽  
Pulmonary Medicine ◽  
Medical Thoracoscopy ◽  
Exudative Pleural Effusion

Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of <0.05 was considered statistically significant. Results: Fifty patients underwent thoracoscopy for undiagnosed pleural effusion. Most common gross thoracoscopy finding was nodules which was seen in 23 patients. Malignancy was the most common histopathological finding, seen in 22 patients. Minor complications were seen in five patients. A final diagnosis could be made in 41 patients; the diagnostic yield was 82%. Conclusion: Medical thoracoscopy should be performed in all patients in which radiological and pleural fluid examinations could not lead to a definitive diagnosis as it has high sensitivity and a very low rate of complications.

scholarly journals Diagnostic Value and Safety of Medical Thoracoscopy in the Management of Exudative Pleural Effusion

2017 ◽  
Vol 18 (3) ◽  
pp. 139-142
Author(s):  
Mehmet Akif Ozgul ◽  
Erdogan Cetinkaya ◽  
Elif Tanriverdi ◽  
Mustafa Cortuk ◽  
Murat Acat ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Value ◽  
Medical Thoracoscopy ◽  
Exudative Pleural Effusion

scholarly journals Medical thoracoscopy in evaluation of undiagnosed pleural effusion

2019 ◽  
Vol 7 (5) ◽  
pp. 1803
Author(s):  
Khurshid Ahmad Dar ◽  
Sheikh Tariq Sultan ◽  
Ahmed Jamal Jamil ◽  
Nazia Mehfooz ◽  
Naveed Nazir Shah ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Cost Effective ◽  
Histopathological Diagnosis ◽  
Complication Rates ◽  
Safe Procedure ◽  
Diagnostic Modality ◽  
Medical Thoracoscopy ◽  
Multiple Variable ◽  
Age Range

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia.  Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates.

scholarly journals Outcomes and complications of medical thoracoscopy in undiagnosed exudative pleural effusion

2016 ◽  
Vol 10 (2) ◽  
pp. 93
Author(s):  
HeshamAtef Abdel Halim ◽  
MonaM Ahmed ◽  
EhabThabet Aziz ◽  
Rania MohammedMohammed El-Shorbagy
Keyword(s):  
Pleural Effusion ◽  
Medical Thoracoscopy ◽  
Exudative Pleural Effusion

Pleurodesis

2019 ◽  
Vol 40 (03) ◽  
pp. 375-385
Author(s):  
Carla Lamb ◽  
Andrew Li ◽  
Dhaval Thakkar ◽  
Pyng Lee
Keyword(s):  
Pleural Effusion ◽  
Management Strategies ◽  
Therapeutic Interventions ◽  
Chemical Pleurodesis ◽  
Medical Thoracoscopy ◽  
Indwelling Pleural Catheter ◽  
Pleural Catheter ◽  
Benign Pleural Effusion ◽  
Invasive Techniques ◽  
Selection Of

AbstractSymptomatic pleural disease, specifically malignant pleural effusion, refractory benign pleural effusion, and pneumothoraces are common diseases that often require therapeutic interventions. The spectrum of management strategies often includes selection of a chemical pleurodesis agent administered in combination with an indwelling pleural catheter or chest tube.Additionally, there is a role for minimally invasive techniques which include medical thoracoscopy or more advanced video-assisted thoracoscopic approaches. Ongoing clinical trials continue to evolve best practices regarding the optimal sclerosant agents and procedural approaches in the management of these diseases.

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