International Journal of Health and Clinical Research

Yazarlar: Prahlad Dayama, Gunjan Soni, Akhil Bansal, Ganeshee Lal Sharma

Konular:-

Anahtar Kelimeler:Thoracoscopy,Pleural Effusion,Exudative,Undiagnosed.

Özet: Background: Undiagnosed pleural effusions remain a diagnostic challenge for pulmonologists. Medical thoracoscopy should be considered in patients with undiagnosed pleural effusions, particularly those lymphocytic exudative effusions where TB and malignant pleural effusion are clinical possibilities and initial pleural fluid analysis is inconclusive. In Indian scenario, there are fewer studies that have been done on the role of thoracoscopy in cases of pleural effusion. Therefore, this study has been chosen for the diagnostic evaluation for moderate to massive pleural effusion attending the Department of Respiratory Diseases, S.P. Medical College, Bikaner. Materials & Methods: This is a hospital based descriptive type of observational study done on 50 patients those presented with recurrent moderate to massive exudative pleural effusion at department of respiratory disease at S.P. Medical College, Bikaner. Once we consider the patient for thoracoscopic procedure, we record detailed history including smoking habits, history of anti tubercular treatment, occupational history, exposure to asbestos, previous history of pleurocentesis, along with detailed respiratory and other systemic examinations in a proforma. All patients having exudative pleural effusion were further evaluated. When these investigations of pleural fluid failed to provide the diagnosis, it was labelled as undiagnosed exudative pleural effusion and patient were selected for Medical thoracoscopic guided pleural biopsy. Results: The mean age of subjects was 56.0±12.06 years and male to female ratio was 2.12 :1. In case of moderate to massive pleural effusion, shortness of breath was most common pulmonary symptoms. In thoracoscopy of pleural cavity the appearance of pleural surface, mostly nodular pleural surface seen in 29 patients (58%), followed by thickened 16 cases (32%) and smooth surface seen only in 5 cases (10%).Out of 50 cases that remained undiagnosed after repeated biochemical & cytological analysis, 47 patients (94%) were diagnosed by means of thoracoscopic pleural biopsy and 3 patients remained undiagnosed (couldn’t arrive at specific diagnosis to initiate treatment) and thus the sensitivity of medical thoracoscopy in undiagnosed pleural effusion was 94%. Conclusion: We concluded that medical thoracoscopy should be considered in patients with undiagnosed exudative pleural effusions, particularly those lymphocytic exudative effusions where TB and malignant pleural effusion are clinical possibilities and initial pleural fluid analysis is inconclusive. In this study the sensitivity of medical thoracoscopy in undiagnosed exudative pleural effusion was 94%.

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