Diagnosis of exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy

Introduction: Medical thoracoscopy increases the diagnostic yield in patients with non-diagnosed pleural effusion when thoracocentesis and closed pleural biopsy (CPB) are non-diagnostic. Chest ultrasound (US) is a very useful imaging method for pleural diseases and the technique of ultra sound-guided cutting biopsy with a tru-cut needle has been well described. Aim of the work: The aim of this work was to diagnose exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy. Subjects and methods: Forty patients with, non-diagnosed exudative pleural effusion admitted to the chest department, Alexandria university hospital, were enrolled after obtaining informed consents. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations including prothrombin activity and INR, biochemical, pathological and microbiological evaluation of the pleural aspirate and radiological evaluation. Then the patients were divided (randomly) into 2 groups each containing 20 patients. Pleural biopsies were performed using medical rigid thoracoscopy on group 1 and ultrasound guided tru-cut pleural biopsy on group 2. Results: The mean age in-group I was 55.0 ± 13.05 years and in-group II was 52.60 ± 17.77 years. There was no statistically significant difference between the two groups regarding age, sex, smoking, marital status and past medical conditions. There was no statistically significant difference between the two groups regarding radiological findings. There was no statistically significant difference between the two groups regarding the pleural fluid analysis. There was no statistically significant difference between the two groups regarding the gross pleural findings. In group II non- specific pleurisy was found in 5 (25.0%) patients (by thoracoscopy 1 of them was finally diagnosed as metastatic deposits from adenocarcinoma of unknown primary, one was confirmed to be tuberculous pleurisy and the remaining 3 cases were confirmed to be non- specific pleurisy). As regards complications in-group I, local wound infection occurred in 1 (5.0%) patient, and empyema occurred in 1 (5.0%) patient. In-group II, local wound infection occurred in 1 (5.0%) patient, and empyema occurred in 1 (5.0%) patient. Conclusion: It is better to use thoracoscopy in cases of undiagnosed exudative pleural effusion presented with a sufficient amount of pleural fluid to avoid lung injury while inserting the trocar. Whereas, ultrasound guided tru-cut pleural biopsy may be used in cases of undiagnosed exudative pleural effusion presented with thickened pleura but with an insufficient amount of pleural fluid