SESSION TITLE: Pleural
SESSION TYPE: Slide Presentations
PRESENTED ON: Sunday, March 23, 2014 at 04:15 PM - 05:15 PM
PURPOSE: Study objective: To evaluate the role of rigid medical thoracoscopy in the management of patients with undiagnosed exudative pleural effusion.
METHODS: Design: Prospective study. Setting: Alexandria university. Subjects: Sixty patients with undiagnosed exudative pleural effusion. Methods: Medical thoracoscopy.All included patients were subjected to medical thoracoscopy using rigid scopes for either diagnostic purposes or both diagnostic and therapeutic purposes.
RESULTS: The current study enrolled 60 patients with symptomatic undiagnosed exudative pleural effusion. Medical thoracoscopy using rigid non-disposable, re-sterilizable instruments was performed in all studied patients for diagnostic and/or therapeutic purposes. The mean age was 53.9 years (SD 13.9 years). Forty-eight (80%) patients lied in the age group between 40 and 80 years. The number of male patients was 36 (60%) while 24 (40%) patients were females. Pleural nodules were the commonest lesions detected as 37 (61.7%) patients. Pleural plaques were found in 24 (40%) patients, pleural masses in 6 (10%) patients, focal pleural thickening in 10 (16.7%) patients and pleural peel in 20 (33.3%) patients. There was significant positive correlation between the pleural nodules and the occurrence of complications (X2=4.435, p=0.037). Adhesions inside the pleural space during thoracoscopy, 24 (40%) patients were adhesion-free “grade 0”. Adhesions were grade 1 in 15 (25%) patients, grade 2 in 9 (15%) patients, grade 3 in 11 (18.3%) patients and grade 4 in a single patient. Pleural biopsy was of benign nature in 21 (35%) patients (TB pleuritis in 7 (11.7%) patients and non-specific pleurisy (NSP) in 14 (23.3%) patients), while malignant pleural biopsy was diagnosed in 39 (65%) patients (Bronchial carcinoma in 16 (26.7%) patients , malignant mesothelioma in 7 (11.7%) patients, metastasis from cancer ovary in 3 (5%) patients, cancer breast in 2 (3.3%) patients, adenocarcinoma of unknown primary in 8 (13.2%) patients and other malignancies in 3 (5%)patients. Thoracoscopic therapeutic interventions succeeded in 22 (88%) patients and failed in 3 (12%) patients.
CONCLUSIONS: Rigid Medical thoracoscopy in the hands of pulmonologists is generally safe, cheap, and highly effective in obtaining a histopathological diagnosis.
CLINICAL IMPLICATIONS: Medical thoracoscopy is an important diagnostic tool for the chest physician at hospitals where patients can not afford expensive surgical VATS and at the same time results are conclusive.
DISCLOSURE: The following authors have nothing to disclose: Essam Hassanein, Eman Hatata, Suzan Helal, Emad Ibrahim, Ayman Baess
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