What is the role of a medical thoracoscopy (pleuroscopy) in the workup of pleural effusion of unknown origin?

Updated: Apr 18, 2019
  • Author: Rajiv Malhotra, DO, MS, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Pleural Effusion of Unknown Origin

Cytologic examination of pleural fluid is only diagnostic in 60-80% of patients with metastatic pleural involvement and in less than 20% in patients with mesothelioma. [3] In cases for which the initial evaluation of a pleural effusion is nondiagnostic and malignancy is suspected, medical thoracoscopy and parietal pleural biopsy should be considered. [4] Medical thoracoscopy with pleural biopsy, as shown in the image below, establishes a diagnosis in more than 90% of the cases. [5]

Biopsy forceps sampling parietal pleura. Biopsy forceps sampling parietal pleura.

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