Role of Medical Thoracoscopy in Undiagnosed Exudative Pleural Effusion – An Experience in Tuberculosis and Chest Diseases Center in South India

Background: In any exudative pleural effusion, most of the times, the commonly identified etiology could be either tuberculosis or malignancy in our Centre. In our experience, usually pleural effusion diagnosed as probably of tuberculous etiology were straw coloured, exudative effusion with ADA above 45 and those diagnosed as malignancy were exudative, straw colored or hemorrhagic effusion with positive cytology for malignant cells. When this criteria were not met, we looked for additional investigations to find etiology of pleural effusion. So we utilized Medical Thoracoscopy to identify the etiology and presented here our experience with Medical Thoracoscopy in such cases. Aim and Objective: The aim of the study was to examine the diagnostic yield of Medical Thoracoscopy in undiagnosed exudative pleural effusion. Material and Methods: This retrospective study was carried out at the Govt Thiruvotteeswarar Hospital of Thoracic Medicine in Chennai. we analyzed all the case sheets and Thoracoscopy procedure records of patients with undiagnosed pleural effusion, who were subjected to Medical Thoracoscopy in our Centre from January 2019 to December 2019. It included 25 patients with undiagnosed pleural effusion. We collected demographic details, symptoms, smoking history, CT chest findings and Medical Thoracoscopic findings, brush/biopsy reports from the records. Pleural fluid analysis reports were also analyzed. Results: The present study included 14 men and 11 women patients, with a mean age of 54.4 ± 16.16 years. Dyspnea was the most common presenting symptom (96%) followed by cough (84%) among the studied patients. Seventeen (70.8%) patients had right-sided pleural effusion. The diagnostic yield of Medical Thoracoscopy among the studied patients was 68 %. The histopathological yield of Thoracoscopic pleural biopsies was as follows: 10 (40%) malignant cases and 7 (28%) patients with tuberculous pleural effusion. There were eight (32%) patients who were not diagnosed. The post-thoracoscopic complications in this study occurred only in seven (28%) patients, which were pain, surgical emphysema and trapped lung. Conclusion: Medical Thoracoscopy is an additional diagnostic procedure which can improve our diagnostic yield in undiagnosed pleural effusions. It is a safe procedure which can be done under conscious sedation and local anaesthesia. Wherever the facility is available, it can be utilized to find out etiology of pleural effusion.