The role of thoracoscopy in the evaluation and management of pleural effusions

Lung. 1990;168 Suppl:1113-21. doi: 10.1007/BF02718251.

Abstract

Diagnostic thoracoscopy is indicated in every patient where the usual investigations (including biochemistry, cytology, bacteriology, occasionally needle biopsy of the pleura) do not achieve a precise diagnosis. The percentage of so-called "idiopathic" effusions, amounting to approximately 20% in many published series, can be reduced to 4% after thoracoscopy. The sensibility of thoracoscopic biopsy reaches 93-97% of malignant or tuberculous pleural effusions. The procedure requires a short hospitalization of about 36 hr, and complications are rare. Therapeutic thoracoscopy is frequently performed in chronic, malignant, recurrent effusions in order to achieve a pleurodesis by means of a talc poudrage under visual control. The efficacy of the poudrage in the published randomized studies is better than tetracycline. About 90% of patients are cured, the effusion being totally suppressed. Side effects are rare if the quantity of talc does not exceed 10 ml.

Publication types

  • Review

MeSH terms

  • Diagnosis, Differential
  • Humans
  • Pleura / pathology
  • Pleural Effusion / etiology*
  • Pleural Effusion / therapy
  • Pleural Neoplasms / pathology
  • Pleurisy / pathology
  • Thoracoscopy / methods*
  • Tuberculosis, Pleural / pathology