Diagnostic utility of medical thoracoscopy in miscellaneous conditions other than tuberculosis and malignancy- a retrospective analysis.

<bold>Methods:</bold> This study is a retrospective analysis of diagnostic thoracoscopy performed by the author in exudative pleural effusion cases due to causes other than tuberculosis and malignancy, two major aetiology in India. Medical thoracoscopy was performed using rigid thoracoscope in cases with non-diagnostic pleural fluid examination and closed pleural biopsy. At least five thoracoscopic parietal pleural biopsy specimens were obtained from sites exhibiting abnormality for microbiological and histopathological studies. <bold>Results:</bold> Among 25 cases in this study, 7 had Rheumatoid arthritis,6 pyogenic pleuritis, 5 Systemic Lupus Erythematosus(SLE),3 MCTD,3 benign pleural fibroma and 1 asbestos pleuritis. All had lymphocyte predominant exudative effusions with negative pleural fluid immunological markers and cytology for malignant cells. Pleural fluid ADA levels varied from 30 U/L to 56 U/L and pleural fluid microbiology was negative for bacteria, fungi and mycobacteria. Pleural fluid TB PCR was negative. At thoracoscopy whitish exudation with multiple nodules were seen in 4 cases while in the remaining wide spread fibrinous deposits and non- specific pleuritis were observed. Histopathology excluded malignancy and revealed fibrinoid necrosis in 14 cases, ill-defined granuloma in 5 and non-specific pleuritis in all cases. Pleural biopsy was negative for AFB. <bold>Conclusions:</bold> Medical thoracoscopy is a safe and an excellent diagnostic method to establish the etiology of pleural effusion. It reliably excludes malignancy and tuberculosis and final diagnosis can be achived with almost 100% sensitivity and specificity.