DIAGNOSTIC UTILITY OF MEDICAL THORACOSCOPY IN UNDIAGNOSED EXUDATIVE PLEURAL EFFUSION AT A TERTIARY CARE HOSPITAL

Medical thoracoscopy is considered a relevant diagnostic device for undiagnosed exudative pleural effusion cases. It offers a scarcely interfering to directly visualize the pleural space and obtain tissue samples for accurate diagnosis, especially when other methods like pleural fluid analysis are inconclusive; it is often recommended when the cause of a significant pleural effusion remains unclear, particularly if malignancy is suspected. One of the most common indications for pleuroscopy is undiagnosed pleural effusion, which comprises about 25% of all cases of pleural effusions, which remain undiagnosed despite primary tests. Background: Medical thoracoscopy (MT) is an extremely valuable tool in the diagnosis of exudative pleural effusions which remain undiagnosed even after thoracentesis because it allows obtaining pleural biopsy under direct vision. Methods: This study is a descriptive observational study done on 45 patients with undiagnosed exudative pleural effusion (inconclusive after repeated pleural fluid analysis) who underwent medical thoracoscopy and direct pleural biopsy. The study was done at a tertiary care hospital in India over 2 years. Results: Among the 45 patients in the study, the clinical, laboratory and the radiological findings could not predict the accurate histological diagnosis with certainty. MT was safe and had an excellent procedural yield (93.3%) in our study. Malignancy and Tuberculosis were the leading histological diagnoses (37.7% each). 8 patients (17.78%) were diagnosed to have nonspecific pleuritis, one (2.22%) patient had empyema and 4.44% (2/45) were inconclusive. Conclusions: Medical thoracoscopy is an extremely useful and safe diagnostic tool with excellent diagnostic accuracy in obtaining a conclusive histologic diagnosis of exudative pleural effusion of unknown etiology.