Title: Pleuroscopy in Undiagnosed Exudative Pleural Effusion, Early Experience in Tertiary Hospital in Bangladesh
Authors: Dr Mohammad Towfique Hasan, Dr Md. Alauddin, Dr Jalal Mohsin Uddin, Dr Mahfuza Tayeba Yasmin
DOI: https://dx.doi.org/10.18535/jmscr/v10i5.03
Abstract
Introduction: Pleural effusion is a clinical condition which caused by a variety of illnesses such as TB, cancer, parapneumonia, congestive heart failure, pulmonary embolism, and many more and most often it seen in patients with lung cancer.
Objective: The main objective of this study is to determine the diagnostic accuracy and problems associated with flexible pleuroscopy.
Materials and Method: This prospective study was conducted at tertiary hospital in Bangladesh. The duration of this study was one year (January 2020 to December 2020). Sample size: Total 60 patients with exudative pleural effusion was selected as sample diagnosed by chest x-ray, CT scan of chest and pleural fluid study (Protein, sugar, LDH) in whom diagnosis couldn’t be confirmed were consider for this study. Flexible pleuroscopy was performed aseptically under local anaesthetic in the 5th or 6th intercostal gaps in the mid-axillary line, and many (5-6) parietal pleura samples were collected in questionable locations.
Results: the patients were on average 56.7 years old, with 58.83 percent male and 41.67 percent female. Nearly 46.67 percent of individuals acquired flexible pleural effusions and 48.33 percent developed left pleural effusions. Three individuals had bilateral illness. Average value of pleural fluid for sugar is 6.6 mmol/L, protein is 4.2 g/dl and ADA is 46 U/L. In all, 95.7% of patients had a conclusive diagnosis. Only 8.7% of patients tested positive for malignant cells in a pleural fluid investigation, despite the fact that 60.8% of those tested had primary and secondary malignancies. Only 26.1% of patients were found to have TB, despite the fact that no tubercular organism could be found in either cytology or culture on any of them. Among the patients who underwent testing, 4.3% had empyema thoracis identified, and the same number of patients had normal pleura. Only two individuals (4.3 percent) had data that might be considered definitive.
Conclusion: Flexible pleuroscopy is a very important method for diagnosing previously undiscovered exudative pleural effusions when thoracentesis failed to provide an appropriate diagnosis.
Keywords: Pleural effusion, Flexible pleuroscopy, TB.
References
- Valdés, D. Alvarez, J. M. Valle, A. Pose, and E. San José, “The etiology of pleural effusions in an area with high incidence of tuberculosis,” Chest, vol. 109, no. 1, pp. 158–162, 1996.
- V. Nance, R. W. Shermer, and F. B. Askin, “Diagnostic efficacy of pleural biopsy as compared with that of pleural fluid examination. Modern pathology: an official journal of the United States and Canadian Academy of Pathology,” Inc, vol. 4, no. 3, pp. 320–324, 1991.
- Rand and I. Maskell, “Introduction and methods: British Thoracic Society pleural disease guideline 2010,” Thorax, vol. 65, no. 2, pp. 1–3, 2010.
- [4] Sinzobahamvya and H. P. Bhakta, “Pleural exudate in a tropical hospital,” Eur. Respir. J., vol. 2, no. 2, pp. 145–148, 1989.
- Emad and G. R. Rezaian, “Diagnostic value of closed percutaneous pleural biopsy vspleuroscopy in suspected malignant pleural effusion or tuberculous pleurisy in a region with a high incidence of tuberculosis: a comparative, age-dependent study,” Respir. Med., vol. 92, no. 3, pp. 488–492, 1998.
- W. Light, “Clinical practice. Pleural effusion,” N. Engl. J. Med., vol. 346, no. 25, pp. 1971–1977, 2002.
- H. Poe, “Sensitivity, specificity, and predictive values of closed pleural biopsy,” Arch. Intern. Med., vol. 144, no. 2, p. 325, 1984.
- Feller-Kopman, Pleural disease, an issue of clinics in chest medicine, E-book. Elsevier, 2021.
- G. Prabhu and R. Narasimhan, “The role of pleuroscopy in undiagnosed exudative pleural effusion,” Lung India, vol. 29, no. 2, pp. 128–130, 2012.
- Watanabe, S. Sasada, C. Chavez, Y. Matsumoto, T. Izumo, and T. Tsuchida, “Flex-rigid pleuroscopy under local anesthesia in patients with dry pleural dissemination on radiography,” Jpn. J. Clin. Oncol., vol. 44, no. 8, pp. 749–755, 2014.
- Shujaat, A. A. Bajwa, F. Usman, L. Jones, and J. D. Cury, “Safety and accuracy of semirigidpleuroscopy performed by pulmonary fellows at a major university hospital: our initial experience: Our initial experience,” J. Bronchology Interv. Pulmonol., vol. 20, no. 3, pp. 213–223, 2013.
- N. Mathur and R. Loddenkemper, “Biopsy techniques in the diagnosis of pleural diseases,” European Respiratory Monograph, vol. 7, pp. 120–130, 2002.
- Lee and H. G. Colt, “Rigid and semirigidpleuroscopy: the future is bright,” Respirology, vol. 10, no. 4, pp. 418–425, 2005.
- B. Prakash and H. M. Reiman, “Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases,” Mayo Clin. Proc., vol. 60, no. 3, pp. 158–164, 1985.
- Boutin, J. R. Viallat, P. Cargnino, and P. Farisse, “Thoracoscopy in malignant pleural effusions,” Am. Rev. Respir. Dis., vol. 124, no. 5, pp. 588–592, 1981.
- G. Colt, “Thoracoscopy. A prospective study of safety and outcome,” Chest, vol. 108, no. 2, pp. 324–329, 1995.
- Lee, A. Hsu, C. Lo, and H. G. Colt, “Prospective evaluation of flex-rigid pleuroscopy for indeterminate pleural effusion: accuracy, safety and outcome,” Respirology, vol. 12, no. 6, pp. 881–886, 2007.