Table 1 - uploaded by David P Breen
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Medical thoracoscopy is an important technique for assessment of undiagnosed exudative pleural effusion. It is also important in the management of pleural disease, benign or malignant. Standard equipment available from several manufacturers enables the procedure to be performed through a single port of entry, frequently under conscious sedation. Wi...
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Background and objective:
Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compa...
Objectives:
Risk factors for pneumothorax recurrence after videothoracoscopy for primary spontaneous pneumothorax are still being debated. The goal of this study was to assess whether the pleurodesis technique and other variables are possibly associated with the postoperative ipsilateral recurrence of pneumothorax.
Methods:
We retrospectively co...
Talc pleurodesis has been associated with pleuropulmonary damage, particularly long-term damage due to its inert nature. The present model series review aimed to assess the safety of this procedure by examining inflammatory stimulus, biocompatibility and tissue reaction following talc pleurodesis. Talc slurry was performed in rabbits: 200 mg/kg che...
An 85-year-old ex-smoker being managed conservatively over 2 years for a small right apical pneumothorax presented to the respiratory clinic with suddenly worsening shortness of breath and chest pain. A chest radiograph demonstrated sudden deterioration in the size of his pneumothorax. Previous CT scans had found emphysematous cystic changes within...
Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk for numerous pulmonary complications, including secondary spontaneous pneumothorax (SSP) and lung herniation. We describe the case of a 66-year-old female patient with severe COPD and previous lingula-sparing left upper lobectomy from adenocarcinoma who presented to...
Citations
... Complications during thoracoscopy can be minimized by following strict standards of operation [6]. Choosing the position carefully at the outset with available radiographs, computed tomography, and ultrasound can help prevent complications [17]. Lung laceration is the most serious complication of medical thoracoscopy, but it can be managed well [15,16]. ...
... Safety: Medical thoracoscopy is generally considered a safe procedure with rare complications [15]. Maintaining safety standards is paramount, and healthcare professionals can minimize the risk of adverse events by adhering to established protocols and taking necessary precautions during the procedure [17]. The rarity of complications underscores the procedure's safety profile, further reinforcing its viability as a valuable tool in managing pleural effusions. ...
... When the etiology of a pleural effusion remains unclear, thoracoscopy can be employed to obtain pleural fluid for chemical, microbiological, and cytological analysis, providing valuable information about the underlying disease process [22]. Additionally, medical thoracoscopy with pleural biopsy has been shown to establish a diagnosis in more than 90% of cases, particularly in idiopathic and malignant pleural effusions [17]. This procedure allows for direct visualization of the pleura and targeted biopsy, identifying specific etiologies such as malignancy or inflammatory conditions [17]. ...
Pleural effusion, characterized by abnormal fluid accumulation in the pleural cavity, poses diagnostic and therapeutic challenges across various medical conditions. This comprehensive review explores the role of medical thoracoscopy in assessing pleural effusions, providing insights into its historical context, procedural intricacies, diagnostic performance, safety considerations, and clinical applications. Medical thoracoscopy, a minimally invasive endoscopic procedure, offers advantages such as high diagnostic yield, therapeutic interventions, real-time assessment, and a minimally invasive nature. The review critically analyzes the procedure's advantages and disadvantages, including technical expertise, risk of complications, resource intensity, and patient selection criteria. Comparative analyses with alternative diagnostic modalities highlight the unique benefits of medical thoracoscopy in specific clinical scenarios. The diagnostic yield of medical thoracoscopy is examined, considering sensitivity and specificity in various contexts. Patient selection criteria, complications, and safety measures are discussed, emphasizing the importance of careful consideration in integrating thoracoscopy into clinical practice. The review further explores its clinical applications, including differentiating exudative and transudative effusions, identifying specific etiologies, and its role in treatment planning. In conclusion, medical thoracoscopy emerges as a valuable tool in the comprehensive management of pleural effusions, offering a nuanced approach to diagnosis and treatment. The evolving landscape of diagnostic modalities underscores the continued significance of medical thoracoscopy and potential advancements in the field.
Pleural infection is a major problem that affects 80 000 cases per year in the UK and USA. It is increasing in incidence, and in an ageing population, it presents a complex challenge that requires a combination of medical therapies and may lead to the need for surgery. This article focuses on the role of the interventional pulmonologist in the diagnosis and management of pleural infection. In particular, we examine the role of pleural ultrasound in diagnostics, thoracocentesis and real-time guided procedures, and the current management strategies, including the controversial role of medical thoracoscopy.
The aim of this study was to evaluate the diagnostic value of interleukin 21(IL-21) and carcinoembryonic antigen (CEA) in tuberculous pleural effusions (TPEs) and malignant pleural effusions (MPEs). Pleural effusion samples from 103 patients were classified on the basis of diagnosis as TPE (n=51) and MPE (n=52). The concentration of IL-21 was determined by ELISA. Lactate dehydrogenase (LDH), adenosine dehydrogenase (ADA) and CEA levels were also determined in all patients. A significant difference was observed in the levels of ADA and CEA (P<0.01), but not in the levels of LDH (P>0.05) between TPE and MPE. The concentration of IL-21 in MPE was significantly higher compared to TPE (P<0.01). With a threshold value of 4.32 pg/ml, IL-21 had a sensitivity of 76.9% (40/52) and a specificity of 80.4% (41/51). Combined detection of IL-21 and CEA had a sensitivity of 69.2% (36/52) and a specificity of 92.2% (47/51). These two markers can contribute to the differential diagnosis of MPEs.
Minithoracoscopy, currently defined as thoracoscopy with instruments of a diameter between 2 and 5 mm, is part of the general evolution of endoscopy towards mini-invasiveness. Its most relevant indications in the field of medical thoracoscopy are small effusions, pleural effusions in patients with narrow intercostal spaces and suspected tuberculous pleurisy in areas of low incidence of tuberculosis. In general, it increases the versatility of medical thoracoscopy. Copyright (C) 2011 S. Karger AG, Basel
