PLEUROSCOPY: AN IMPORTANT DIAGNOSTIC TOOL FOR A PULMONOLOGIST

Nausheen Saifullah, Nadeem Rizvi
2012 Pakistan Journal of Chest Medicine   unpublished
Pleural diseases are common problems in pulmonary practice. About 20% of pleural effusions remain undiagnosed despite repeated thoracocentesis and close needle biopsy. When these patients were subjected to diagnostic pleuroscopy its diagnostic yield was found to be 95% for malignancies and 100% for benign diseases. Pleuroscopy today is primarily a diagnostic procedure, but it can also be applied for therapeutic purposes. Contraindications to pleuroscopy are uncommon and rarely absolute.
more » ... y absolute. Pleuroscopy is a safe and effective treatment modality in the diagnosis and treatment of several pleuropulmonary diseases, if standard criteria are fulfilled. Authors have recently completed a study on comparison of pleuroscopy with Abram's biopsy in the diagnosis of exudative pleural effusion at Jinnah Post Graduate and Medical Center. In that study the yield of pleuroscopy was 97% whereas that of Abram's biopsy was 70%. BACKGROUND Pleural diseases (e.g. pleural effusions, pleural based masses, and pneumothoraces) are common problems in pulmonary practice. Approximately a million patients worldwide develop pleural effusion each year 1. The frequency of various causes of pleural effusion depends on the incidence of tuberculosis in the region. In an area with a high incidence of tuberculosis the commonest cause of pleural effusion include tuberculosis (25%) neoplasm (22.9%) congestive cardiac failure (17.9%) and pneumonia (14%) 2. If a pleural biopsy specimen is needed, a physician must usually choose between a blind pleural biopsy and a surgical procedure. The latter requires general anesthesia in the operating room and is expensive, and the former is positive in only 40 to 60% of patients with malignant pleural disease 3 and around 75% in patients with tuberculosis 4. Pleuroscopy performed on patients under conscious sedation is a viable alternative. The procedure has a low rate of complications, with one study reporting major and minor complication rates of 6% and 18.4% respectively 5. About 20% of pleural effusions remain undiagnosed despite repeated thoracocentesis and close needle biopsy. When these patients were subjected to diagnostic pleuroscopy its diagnostic yield was found to be 95% for malignancies and 100% for benign diseases 6 .
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