Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India
Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cy...
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doaj-c65a6b6aa30c4dc1a5bf50ccff503d022021-05-18T11:23:51ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2020-09-01149OC16OC2010.7860/JCDR/2020/44095.13990Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, IndiaMOHAMMAD ARIF0RAKESH BHARGAVA1MOHAMMAD SHAMEEM2NAFEES AHMAD KHAN3SADAF SULTANA4Senior Resident, Department of Pulmonary Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.Professor, Department of Pulmonary Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.Professor, Department of Pulmonary Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.Assistant Professor, Department of Pulmonary Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.Junior Resident, Department of Radiodiagnosis, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of <0.05 was considered statistically significant. Results: Fifty patients underwent thoracoscopy for undiagnosed pleural effusion. Most common gross thoracoscopy finding was nodules which was seen in 23 patients. Malignancy was the most common histopathological finding, seen in 22 patients. Minor complications were seen in five patients. A final diagnosis could be made in 41 patients; the diagnostic yield was 82%. Conclusion: Medical thoracoscopy should be performed in all patients in which radiological and pleural fluid examinations could not lead to a definitive diagnosis as it has high sensitivity and a very low rate of complications.https://jcdr.net/articles/PDF/13990/44095_CE[Ra1]_F(SL)_PF1(AG_KM)_PFA(KM)_PB(AG_KM)_PN(SL).pdfpleuroscopypleural biopsythoracocentesisundiagnosed pleural fluid |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
MOHAMMAD ARIF RAKESH BHARGAVA MOHAMMAD SHAMEEM NAFEES AHMAD KHAN SADAF SULTANA |
spellingShingle |
MOHAMMAD ARIF RAKESH BHARGAVA MOHAMMAD SHAMEEM NAFEES AHMAD KHAN SADAF SULTANA Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India Journal of Clinical and Diagnostic Research pleuroscopy pleural biopsy thoracocentesis undiagnosed pleural fluid |
author_facet |
MOHAMMAD ARIF RAKESH BHARGAVA MOHAMMAD SHAMEEM NAFEES AHMAD KHAN SADAF SULTANA |
author_sort |
MOHAMMAD ARIF |
title |
Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India |
title_short |
Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India |
title_full |
Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India |
title_fullStr |
Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India |
title_full_unstemmed |
Diagnostic Yield of Medical Thoracoscopy in Undiagnosed Exudative Pleural EffusionA Tertiary Centre Experience from Aligarh Muslim University, Uttar Pradesh, India |
title_sort |
diagnostic yield of medical thoracoscopy in undiagnosed exudative pleural effusiona tertiary centre experience from aligarh muslim university, uttar pradesh, india |
publisher |
JCDR Research and Publications Private Limited |
series |
Journal of Clinical and Diagnostic Research |
issn |
2249-782X 0973-709X |
publishDate |
2020-09-01 |
description |
Introduction: Pleural effusions are one of the most common
entities encountered by pulmonologists worldwide which have
a very long list of causes. Initial workup of these patients begins
with a chest X-ray and percutaneous or Ultrasound (USG)
guided thoracocentesis followed by biochemical and cytological
evaluation of the fluid to ascertain the cause of effusion. A 20 to
25% of cases remain undiagnosed even after thoracocentesis
and closed pleural biopsy. Medical Thoracoscopy is emerging
as a safe diagnostic procedure in these patients.
Aim: To detect the diagnostic yield of medical thoracoscopy in
cases of undiagnosed exudative lymphocytic pleural effusion
and to study the complications associated with it.
Materials and Methods: This was a prospective observational
study, carried out in the Department of Pulmonary Medicine, JN
Medical College and hospital, Aligarh Muslim University (AMU),
Aligarh, Uttar Pradesh, India, from August 2016 to August
2018. Undiagnosed exudative pleural effusion was defined as
pleural effusion with Adenosine Deaminase (ADA) levels less
than 70 IU/L and negative pleural fluid cytology for malignancy.
Thoracoscopic examination of the pleural space using flexi-rigid
thoracoscopy was done and biopsy was taken from suspected
areas and the tissue obtained, was send for histopathological
examination. The results were presented as mean±SD (Standard
Deviation) or percentage. Differences in categorical data were
compared using the chi-square test or the Fisher-exact test. A
p-value of <0.05 was considered statistically significant.
Results: Fifty patients underwent thoracoscopy for undiagnosed
pleural effusion. Most common gross thoracoscopy finding was
nodules which was seen in 23 patients. Malignancy was the
most common histopathological finding, seen in 22 patients.
Minor complications were seen in five patients. A final diagnosis
could be made in 41 patients; the diagnostic yield was 82%.
Conclusion: Medical thoracoscopy should be performed in all
patients in which radiological and pleural fluid examinations
could not lead to a definitive diagnosis as it has high sensitivity
and a very low rate of complications. |
topic |
pleuroscopy pleural biopsy thoracocentesis undiagnosed pleural fluid |
url |
https://jcdr.net/articles/PDF/13990/44095_CE[Ra1]_F(SL)_PF1(AG_KM)_PFA(KM)_PB(AG_KM)_PN(SL).pdf |
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