Intrapleural urokinase directly under medical thoracoscopy for the diagnosis of tuberculous pleurisy

Our plain-English summary of Intrapleural urokinase directly under medical thoracoscopy for the diagnosis of tuberculous pleurisy, by S. Terashita, H. Kawachi, T. Tajiri, et al (Respirology Case Reports, 2020).

The study

• Authors: S. Terashita, H. Kawachi, T. Tajiri, S. Noguchi, T. Ikeue, T. Sugita
• Journal: Respirology Case Reports
• Published: 2020;8(1):e00498
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Medical thoracoscopy, also called "local anesthetic thoracoscopy" and "pleuroscopy," is a minimally invasive single-port endoscopic technique that provides direct visualization of the pleural surfaces and channels to conduct diagnostic and therapeutic procedures. However, this technique is not helpful when substantial fibrous adhesions exist. We reported the first case of intrapleural urokinase directly under medical thoracoscopy for the diagnosis of malignant pleural mesothelioma with severe multiloculated pleural effusions in 2019. This is the second report regarding the efficacy of intrapleural urokinase directly under medical thoracoscopy for the diagnosis of multiloculated pleural effusions. Urokinase-induced intrapleural fibrinolysis, which removed the fibrous septa, consequently improved the field of view under endoscopy within only 10 min. Fibrinolytic effect appeared very rapidly. This technique is available for tuberculous pleurisy with severe multiloculated pleural effusion.

© 2019 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This article was a case report of one patient, written by doctors at the Japanese Red Cross Wakayama Medical Center in Japan. The patient was an 88-year-old man with diabetes who had large fluid collections around the left lung (pleural effusions). Two earlier fluid samples had not found the cause. When the doctors looked inside the chest with a medical thoracoscope (a thin camera tube), dense strands of fibrin blocked the view. They injected 60,000 IU of urokinase, a clot-dissolving drug, in 100 mL of saline through the scope. About 10 minutes later the strands near the scope had dissolved. The doctors could then see small white nodules on the chest wall lining and take biopsies. No bleeding, fever or allergic reactions were noted. The biopsies showed tuberculosis bacteria, and the patient was diagnosed with tuberculous pleurisy. The article does not mention asbestos. The authors' earlier report used the same method in a patient with malignant pleural mesothelioma. The authors concluded that the procedure may expand what medical thoracoscopy can diagnose. They noted that the right urokinase dose is not fully understood.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 88-year-old man with diabetes mellitus and large left-sided pleural effusions; the authors are from the Japanese Red Cross Wakayama Medical Center, Japan; dates of care not given
• Exposure: No asbestos or other occupational exposure is reported. The article describes a procedure, not an exposure: 60,000 IU urokinase in 100 mL of 0.9% saline given through the biopsy port of a semirigid thoracoscope
• Main results:
  • Before the thoracoscopy, two diagnostic fluid drainages gave no bacterial growth and negative acid-fast bacilli smears
  • About 10 minutes after urokinase was given, the fibrous strands near the thoracoscope had dissolved in this patient
  • With the view cleared, the doctors saw multiple small white nodules on the parietal pleura and biopsied them
  • No complications were noted in this patient; the examination took 62 minutes
  • The biopsy specimens were positive for acid-fast bacilli and for Mycobacterium tuberculosis by PCR, and tuberculous pleurisy was diagnosed
• The authors' conclusion: The authors concluded that giving urokinase directly under medical thoracoscopy may expand the diagnostic capability of medical thoracoscopy for multiloculated pleural effusions
• Limitations the authors state:
  • The appropriate dose of urokinase is still incompletely understood

Topics

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Tuberculous pleurisy, Thoracoscopy, Pleural Mesothelioma, Pleural Effusion, Endoscopy.

Related studies

• Intrapleural Urokinase Directly Under Medical Thoracoscopy for the Diagnosis of Malignant Pleural Mesothelioma With Severe Multiloculated Pleural Effusions — S. Terashita, H. Kawachi, et al. (2019)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Utility of Ascitic Fluid Adenosine Deaminase Levels in the Diagnosis of Tuberculous Peritonitis in General Medical Practice — A. Kumabe, S. Hatakeyama, et al. (2020)
• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis — Y. Wei, K. Shen, et al. (2020)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)

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