Fiberoptic thoracoscopy in management of exudative pleural effusion

Objectives: Exudative pleural effusion represents a common diagnostic task to the clinician. The two commonest causes of exudative pleural effusion are parapneumonic followed by malignant ones. However, obtaining a definite diagnosis is essential for proper management of the effusion. The aim of this work was to evaluate the role of the fiberoptic bronchoscope used as a thoracoscope in management of exudative pleural effusion. Patients and methods: Eighty-four patients with exudative pleural effusion of undetermined etiology were enrolled in this study. All patients were subjected to full history taking, thorough clinical examination, pleural fluid aspiration and analysis, computed tomography of the chest and ultrasound examination of the pleural cavity. Under conscious sedation and local anaesthesia, fiberoptic thoracoscopy was then carried out using fiberoptic bronchoscope inserted through a rigid large siliconized chest tube. After drainage of the pleural fluid, the pleural cavity was carefully explored and multiple forceps biopsies were taken and sent for histopathological examination. Pleurodesis was then done using iodopovidone in patients with apparent pleural pathology. After lung expansion and pleural fluid drainage of less than 100 cc/day, the chest tube was removed. Results: Successful histopathological diagnosis was achieved in all patients. It revealed that 63 (75%) cases had malignant pathology and 21 (25%) cases had inflammatory pathology. The malignant pathology was caused by: bronchogenic carcinoma in 28 (33.3%) cases, malignant mesothelioma in 2 (2.38%) cases and metastatic malignant deposits from other organs in 33 (39.28%) cases. The inflammatory pathology was tuberculosis in 16 (19%) cases and non-specific pleurisy in 5 (5.95%) cases. Pleurodesis was performed and was successful in all the patients. Two (2.38%) patients developed empyema after the procedure and they were successfully managed by intercostal tube drainage and anitibiotic therapy. Other complications encountered included local wound infection in 3 (3.57%) cases, subcutaneous emphysema in 3 (3.57%) cases and chest pain following pleurodesis in 15 (17.85%) cases. Conclusion: Thoracoscopy using the fibroptic bronchoscope is safe and effective. It is an alternative technique to rigid thoracoscopy with some advantages as it allows better exploration of the pleura. It is equally as efficient as the rigid thoracoscope and hardly more time consuming. With proper handling, there will not be any damage or abuse of the fibroptic bronchoscope