What is the role of medical thoracoscopy in the workup for pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Pleural biopsy should be considered, only if TB or malignancy is suggested. Medical thoracoscopy with the patient under conscious sedation and local anesthesia has emerged as a diagnostic tool to directly visualize and take a biopsy specimen from the parietal pleura in cases of undiagnosed exudative effusions. As an alternative, closed-needle pleural biopsy is a blind technique that can be performed at the patient's bedside.

Medical thoracoscopy has a higher diagnostic yield for malignancy. Closed-needle pleural biopsy findings aid in diagnosis of only 7-12% of malignant effusions when cytology findings alone are negative. However, the yield of closed-needle pleural biopsy (histology plus culture) is as high as thoracoscopy for tuberculous pleuritis and is a useful alternative procedure for this diagnosis when available.


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