Validity of Pleuroscopy in Evaluating Pleural Effusions of Uncertain Etiology at the Cardiothoracic Unit of Minia University Hospital, Egypt

Our plain-English summary of Validity of Pleuroscopy in Evaluating Pleural Effusions of Uncertain Etiology at the Cardiothoracic Unit of Minia University Hospital, Egypt, by A. Abdelaziz, R. Hassan, R. Abdelfattah, et al (Curēus, 2024).

The study

• Authors: A. Abdelaziz, R. Hassan, R. Abdelfattah, A. Hassan, H. Yehia, A. Mady, E. Abdelhady
• Journal: Curēus
• Published: 2024;16(4):e59300
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Pleural effusion is a medical condition where an excessive amount of fluid accumulates in the pleural space. This can be caused by inflammation or malignant growth in the body. Doctors use medical thoracoscopy for both diagnostic and therapeutic purposes. This technique allows them to view the internal pleural surfaces and take biopsies of any abnormal lesions within the pleural cavity.

Objective: This work aimed to evaluate the diagnostic value of pleuroscopy in patients with undiagnosed exudative pleural effusion.

Patients And Methods: A study was conducted on 61 patients who had undiagnosed exudative pleural effusion and were admitted to the chest department at the cardiothoracic unit of the Minia University Hospital. All patients provided written consent and underwent a complete history and clinical examination. Standard laboratory tests, including routine liver and kidney function tests, a complete blood count, and a coagulation profile, were conducted on all patients, along with chest X-rays. If necessary, a chest CT scan was also performed. Diagnostic thoracentesis was done, and the pleural fluid was analyzed for sugar, protein, and lactate dehydrogenase and sent for bacteriological analysis (Gram stain, culture, and acid-fast bacilli smear) and cytopathological examination. Medical thoracoscopy was performed in cases where an etiological diagnosis was not established.

Results: A total of 61 patients with undiagnosed exudative pleural effusions were included. A definitive etiological diagnosis was reached in 58 (95%) patients. In 47 (77%) of the studied group, malignant etiology was confirmed; nine (14.8%) had tuberculous pleurisy, one (1.6%) had empyema, and one (1.6%) had inflammatory/autoimmune pleurisy. A definite diagnosis was not reached in three (5%) patients. The malignant pathology was caused by bronchogenic carcinoma in 20 (42.5%) cases, malignant mesothelioma in 10 (21.3%) cases, metastatic malignant deposits from other organs in six (12.7%) cases, and lymphoma in three (6.5%) cases. No serious adverse events related to the procedure were recorded. The most common minor complications were transient chest pain in 34 (55.7%) patients, followed by surgical emphysema in 10 (16.4%) patients.

Conclusion: Pleuroscopy is an effective diagnostic tool for identifying the cause of pleural effusion when it is unclear. It is a minimally invasive and straightforward procedure associated with high diagnostic accuracy and low complication rates.

Copyright © 2024, Abdelaziz et al.

In plain English

This descriptive cross-sectional study looked at 61 patients admitted to the chest department of the cardiothoracic unit at Minia University Hospital, Egypt, between June 2021 and January 2023. Each had fluid around the lung (an exudative pleural effusion) whose cause earlier tests had not found. Doctors examined the chest lining with a rigid thoracoscope (pleuroscopy) and took biopsies. The biopsies gave a definite diagnosis in 58 of the 61 patients (95%). Cancer was found in 47 patients (77%) and tuberculosis in nine (14.8%). Of the 47 cancers, 20 (42.5%) were lung adenocarcinoma and 10 (21.3%) were malignant pleural mesothelioma. No serious adverse events were recorded. Thirty-four patients (55.7%) had pain at the puncture site and 10 (16.4%) had surgical emphysema. The authors concluded that the procedure is minimally invasive, with a high diagnostic yield and infrequent, non-serious complications. They noted that the study had no comparison group biopsied under ultrasound or CT guidance. The article did not report asbestos exposure for these patients. Its mention of asbestos factories referred to other Egyptian studies, not to these patients.

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: descriptive cross-sectional study
• Who was studied: 61 patients with undiagnosed exudative pleural effusion, admitted to the chest department of the cardiothoracic unit at Minia University Hospital, Egypt, June 2021 to January 2023; mean age 58.34 years, 39 (63.9%) male
• Exposure: The article reports no asbestos or occupational exposure data. What was evaluated was a diagnostic procedure: rigid medical thoracoscopy (pleuroscopy) with biopsy of the parietal pleura.
• Main results:
  • Thoracoscopic biopsy gave a definitive diagnosis in 58 (95%) of 61 patients; 3 cases were non-conclusive
  • Among all 61 patients, malignancy was confirmed in 47 (77%) and tuberculosis in 9 (14.8%)
  • Among the 47 malignant cases, lung adenocarcinoma accounted for 20 (42.5%)
  • Among the 47 malignant cases, malignant pleural mesothelioma accounted for 10 (21.3%)
  • Among the 47 malignant cases, metastatic deposits from other organs accounted for 6 (12.7%) and lymphoma for 3 (6.5%); Table 5 also lists 8 (17%) poorly differentiated carcinoma
  • At thoracoscopy, pleural nodules or masses were seen in 45 (73.8%) and adhesions in 20 (32.8%) of the 61 patients
  • Among the 61 patients, no serious adverse events were recorded; 34 (55.7%) had pain at the puncture site, 10 (16.4%) surgical emphysema, 5 (8.2%) wound infection and 1 (1.6%) empyema
  • Before thoracoscopy, pleural fluid cytology showed atypical cells in 18 (29.5%) of the 61 cases, but this was inconclusive
• The authors' conclusion: The authors concluded that medical thoracoscopy is a minimally invasive technique with a high diagnostic yield and lower rates of non-serious complications in patients whose effusion remains undiagnosed after conventional tests.
• Limitations the authors state:
  • No comparison group of patients biopsied with ultrasound or CT guidance

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Etiology, Inflammation, Medical Thoracoscopy, Pleural Cavity, Chest X-Ray, CT Scan, Thoracentesis.

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• The use of indwelling pleural catheters for the management of malignant pleural effusion--direct costs in a Dutch hospital — R.C. Boshuizen, S. Onderwater, et al. (2013)
• Mesothelioma of the tunica vaginalis: a series of eight cases with uncertain malignant potential — F. Brimo, P.B. Illei, et al. (2010)
• Mesothelioma of tunica vaginalis of "uncertain malignant potential" - an evolving concept: case report and review of the literature — K. Trpkov, R. Barr, et al. (2011)
• Epidemic of mesothelioma in Egypt — R.M. Gaafar, N.H. Eldin (2005)

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