Pleuroscopy in exudative pleural effusion: A North Malaysia experience

Background: Pleuroscopy is one of the investigation modalities available for further evaluation of exudative pleural effusion. Aims of this study is to determine the diagnostic yield and common cause for pleural effusion that underwent pleuroscopy in Respiratory department, Hospital Sultanah Bahiyah .Methods: This is a retrospective descriptive analysis study of 106 patient who underwent pleuroscopy in Hospital Sultanah Bahiyah between July 2014 till Dec 2016. Hospital Sultanah Bahiyah is the only centre doing this procedure in North Malaysia.Result: Biopsy were done in 91% of the cases with diagnostic yield of up to 97%. Most common finding were malignancy (55%) with adenocarcinoma being the commonest subtype. Second commonest finding are granulomatous inflammation (19%) which is not surprising given our burden of tuberculosis. Majority of our patient were male (58%) with mean age of 60 years old. With regard to safety only one case develop complication where the patient develops re-expansion pulmonary oedema with no procedure related mortality.Conclusion: Pleuroscopy is a very safe procedure. Despite the high Tuberculosis burden in Malaysia the most common cause for exudative pleural effusion were due to malignancy, hence pleuroscopy should be consider in all cases of exudative pleural effusion.

The Use of Thoracic Ultrasound to Predict Transudative and Exudative Pleural Effusion

Objectives: Pleural effusion is a common reason for hospital admission with thoracentesis often required to diagnose an underlying cause. This study aimed to determine if the imaging characteristics of TUS effectively differentiates between transudative and exudative pleural fluid. Methods: Patients undergoing TUS with pleural fluid analysis were retrospectively identified at a single center between July 2016 and March 2018. TUS images were interpreted and characterized by established criteria. We determined diagnostic performance characteristics of image criteria to distinguish transudative from exudative pleural effusions. Results: 166 patients underwent thoracentesis for fluid analysis of which 48% had a known malignancy. 74% of the pleural effusions were characterized as exudative by Light’s Criteria. TUS demonstrated anechoic effusions in 118 (71%) of samples. The presences of septations on TUS was highly specific in for exudative effusions (95.2%) with high positive predictive values (89.5%) and likelihood ratio (2.85). No TUS characteristics, even when adjusting for patient characteristics such as heart failure or malignancy, were sensitive for exudative effusions. Conclusions: Among our cohort, anechoic images did not allow reliable differentiation between transudative and exudative fluid. Presence of complex septated or complex homogenous appearance was high specific and predictive of exudative fluid.

Curious case of the unexplained exudative pleural effusion

We report a case of a 74-year-old male patient who was referred to the respiratory clinic with an incidental finding of a left sided pleural effusion. He was initially being treated by the general practitioner for chest infection with productive cough that had limited resolution after course of oral antibiotics. At the pleural clinic, 1.5 L of serosanguineous fluid was drained and sent for diagnostics. However, the diagnosis only reached as far as idiopathic exudative effusion with lymphocytes and plasma cells. He was then referred for video-assisted thoracoscopic surgery pleural biopsy and pleurodesis. It revealed black pleura with abundant IgG4 positive cells. He is followed up in respiratory clinic where further discussion and treatment has commenced.

Pleuroscopy early experience in the exudative pleural effusion of unknown etiology

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.