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2012

2012 June - Impact of medical thoracoscopy on the management of persistent pleural effusion – experience in a district hospital

Dr Tsz-Lun WONG; Department of Medicine, North District Hospital

Background: Persistent or undiagnosed exudative pleural effusion has posed a management problem to physicians. Thus, medical thoracoscopy, also known as pleuroscopy, aids the diagnosis in this group of patients.

Objective: To review the added value of medical thoracoscopy in diagnosis of undiagnosed exudative pleural effusion

Method: A retrospective study to compare pleuroscopy and repeated closed needle pleural biopsy on undiagnosed exudative pleural effusion.

Results: Fifty pleuroscopy sessions were carried out from 1st February 2009 to 17th May 2011. Thirty-eight pleuroscopies were done on cases of exudative pleural effusion and were preceded by at least one closed-needle pleural biopsy. Twenty-two biopsies of repeated closed-needle biopsy were identified from the pre-pleuroscopy period (1st January 2007 to 31st January 2009) for comparison. More male (78.9% vs 54.5%; p=0.047) and patients with positive smoking history (60.5% vs 18.2%; p=0.001) were found in the pleuroscopy subgroup. The diagnostic yield for the category of tuberculous pleuritis, malignant pleural effusion and pleural space infection/empyema was 52.6% in pleuroscopy subgroup vs 22.7% in repeated closed-needle pleural biopsy (p=0.024). Comparison of cases of pleuroscopies without prior biopsies (n=7) with the results of first-time pleural biopsies (n=127) from 1st February 2009 to 17th May 2011 was inconclusive due to small sample size. Analysis of the pleuroscopy group reviewed that complications were usually minor.

Conclusion: Pleuroscopy is a better option for pursuing diagnosis in exudative pleural effusion when previous pleural biopsy revealed inconclusive results. Whether it is worthwhile to employ pleuroscopy as the initial choice of investigation requires further investigation.

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