When is medical thoracoscopy (pleuroscopy) contraindicated?

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

Answer

The major contraindications are related to the ability to perform the procedure. As long as no contraindication exists for the ability to insert instruments into the pleural space, it can be performed safely. Even when the lung is adherent to the chest wall, the use of transthoracic ultrasound by interventional pulmonologists can allow identification of safe areas to insert the trocar and pleuroscope.

A pleural separation of at least 10 mm is recommended to minimize injury to the lung. In patients with small effusions, a pneumothorax may need to be induced by cannulating the pleural space and asking the patient to inspire deeply while the catheter is open to the atmosphere. The presence of a pneumothorax can then be confirmed with either chest radiograph or thoracic ultrasound at the bedside. This procedure is limited by the ability of the patient to tolerate a pneumothorax. In patients who already have an effusion, the concern regarding tolerance of a pneumothorax is not as worrisome because an equal volume of fluid would be replaced by air.

The following relative contraindications may be corrected and accounted for:

  • Refractory cough

  • Hypoxia

  • Coagulopathy

  • Thrombocytopenia


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