Role of medical thoracoscopy in diagnosis of pleuropulmonary lesions

Abstract

Objectives: To assess the analytic utility and wellbeing of pleuroscopy in patients with pleuropulmonary diseases. Patients and Methods: A retrospective and prospective observational clinical study including 179 patients divided into 2 groups; group 1 included 139 patients in Nagoya medical center and Toyota Kosei hospital, Japan with undiagnosed pleural effusions. Group 2 included 40 cases with diffuse parenchymal lung diseases (DPLD) of unknown etiology admitted in Kasr Alainy Hospital, Cairo University. All patients were exposed to clinical assesment, routine laboratory investigation, coagulation profile, arterial blood gases, collagen profile, chest X-ray and CT, pleural fluid analysis in cases with pleural effusion and Spirometry in DPLD. Results: The final histopathological diagnosis in G1 revealed malignancy in 53.2% and benign diagnosis in 46.8% and in G2, hypersensitivity pneumonitis in 20%, UIP in 17.5%, NSIP in 15%, DIP in 10%, LAM in 10%, COP in 7.5%, alveolar proteinosis in 5%, sarcoidosis in 5%, invasive mucoid adenocarcinoma in 5%, Metastatic adenocarcinoma (gastric) in 2.5% and silicosis in 2.5%. Thoracoscopic complications; in G1, bronchopleural fistula in 10.8%, fever in 3.6%, HAI in 1.44%, lung laceration in 2.2% and Subcutaneous emphysema in 0.72% and in G 2; Pneumomediastinum in 2.5%, Surgical emphysema in 7.5%, bronchopleural fistula in 10%, Pneumothorax in 10% and Pulmonary embolism in 2.5%. Conclusions: Medical thoracoscopy is a valuable method in the diagnosis of unexplained pleural lesions, management of empyema and malignant pleural effusion. It is a promising, inexpensive and safe technique in DPLD