Medical video assisted thoracoscopy – minimally invasive diagnostic tool for diagnosis of undiagnosed pleural effusion

Background: The diagnosis of pleural diseases is one of the frequent clinical problems encountered in pulmonary medicine. A variety of diagnostic tests are available for evaluating pleural effusions. It often depends much more on the revealing results of pleural fluid cytology and histopathological examination of the visceral or parietal pleural. Despite thoracocentesis and pleural biopsy, approximately 15–20% of pleural effusions remains undiagnosed.Aim of Work: This study was carried out to establish the efficacy and safety of medical Video Assisted Thoracoscopic (VAT) procedure as a diagnostic modality in undiagnosed exudative pleural effusion.Patients and methods: Thoracoscopy was performed on 71 patients for diagnostic purposes over a period of 2 years from June 2010 to August 2012, in the Department of Chest diseases, El-Hussein University Hospital, Al-Azhar University. Diagnostic thoracoscopy for pleural abnormality was carried out only after pleural fluid examinations and additional closed pleural biopsy was also performed. Histopathological specimen was taken in all cases.Results: Thoracoscopy gives the final diagnosis in 62 cases (87.3%) from totally 71 cases. The most common diagnosis was malignant mesothelioma in 39 cases (54.9%), malignant adenocarcinoma and TB pleurisy in 10 cases (14.1%) for each, non Hodgkin’s lymphoma in 2 cases (2.8%), and lastly malignant melanoma in one case (1.4%).Conclusion: Medical VAT is a safe and accurate diagnostic procedure for pleural diseases but it also has a very useful role in therapy. VAT saves time, effort and cost, moreover it is preferred by the patient as he recovers and returns to his normal activity rapidly