PURPOSE: Because of decreased respiratory reserve, old patients with pleural effusion often suffered from dyspnea. And the managements of plural effusion require multiple diagnostic and therapeutic procedures with long hospital admission and increased costs. Medical thoracoscopy is performed under local anesthesia using only one point of entry. Compared to VATS, it is mini-invasive with less pain, lower costs, shorter hospital stays, better cosmetic results and less risk. Moreover, the possibility to perform pleural effusion drainage with pleural biopsy aids the rapid relief from dyspnea and accurate diagnosis. So, we evaluate the usefulness of primary medical thoracoscopy for the pleural effusion in old patients.
METHODS: 32 patients (≥65 years old) with pleural effusion were enrolled in the study. All patients complained of dyspnea. Patients with hypoalbuminemia, cardiomegaly, bilateral effusion were excluded. As a result of pleural space anatomy, they were divided into two groups as follows; A1: small to moderate free-flowing effusion(>10 mm and <1/2 hemithorax) A2: large, free-flowing effusion (≥1/2 hemithorax), loculated effusion, or effusion with thickened parietal pleura. We performed primary medical thoracoscopy with pleural fluid examination and pleural biopsy and procedures were finished with chest tube insertion.
RESULTS: The mean age of patients was 78.4 years old. No complication occurred during the procedures. We considered pleural biopsy as confirmative diagnosis. In the diagnosis of tuberculous pleurisy, pleural fluid examination showed relatively low sensitivity in A1 group (50%) than A2 group (100%). In the diagnosis of malignant pleural effusion, pleural fluid cytology has very low sensitivity in A1 group (28.6%) than A2 group (72.7%). No long-term sequelae of the procedure occurred.
CONCLUSION: Primary medical thoracoscopy was safe and made it possible to relieve dyspnea and diagnose accurately in old patients. In respect of diagnosis, the usefulness was greater in A1 group.
CLINICAL IMPLICATIONS: Primary medical thoracoscopy should be considered first for the pleural effusion of the aged.
DISCLOSURE: Yang Deok Lee, No Financial Disclosure Information; No Product/Research Disclosure Information