Medical Thoracoscopy in Pleural Disease: Experience from a One-Center Study

Abstract

Background: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital.

Methods: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes. During the procedure, patients were under conscious sedation with fentanyl and midazolam. Medical records were reviewed for clinical data.

Results: From February 2014 to January 2016, 50 procedures (47 cases) were performed (diagnostic MT, 26 cases; therapeutic MT, 24 cases). The median age of patients was 66 years (59-73 years), and 38 patients (80.9%) were male. The median procedure duration from initial incision to insertion of the chest tube was 37 minutes. The median doses of fentanyl and midazolam were 50 µg and 5 mg, respectively. All procedures were performed without unexpected events. Of the 26 cases of pleural disease with an unknown cause, 19 were successfully diagnosed using MT. Additionally, diagnostic MT provided clinically useful information in the other six patients. Therapeutic MT was very effective for treatment of malignant pleural effusion or empyema. The median number of days with chest tube drainage was 6 (3 days for diagnostic MT and 8 days for therapeutic MT).

Conclusion: MT is a useful and necessary procedure for both diagnosis and treatment of pleural diseases.

Keywords: Pleural Diseases; Thoracoscopy.

Figure 1. Flow diagram of patients undergoing medical thoracoscopy. ^*Guidewire. ^†Adenocarcinoma was diagnosed via video-assisted thoracoscopic surgery (VATS) in one patient; two patients were clinically diagnosed with malignant pleural effusion. ^‡Mesothelioma was diagnosed via VATS in one patient, and pleural effusion was spontaneously resolved in another three patients. TB: tuberculosis; NTM: nontuberculous mycobacteria; GVHD: graft-versus-host disease.

Figure 2. Re-expansion pulmonary edema. Chest radiography immediately (A), 4 hours (B), 6 hours (C), and 3 days (D) after medical thoracoscopy.

Figure 3. IgG4-related disease: findings during medical thoracoscopy. (A) Adhesions in the pleural space. (B) Thickened parietal pleura. (C) Inflamed parietal pleura with proliferating blood vessels.