THORACOSCOPY IN UNDIAGNOSED PLEURAL EFFUSIONS

Citation
M. Degroot et G. Walther, THORACOSCOPY IN UNDIAGNOSED PLEURAL EFFUSIONS, South African medical journal, 88(6), 1998, pp. 706-711
Citations number
25
Categorie Soggetti
Medicine, General & Internal
ISSN journal
02569574
Volume
88
Issue
6
Year of publication
1998
Pages
706 - 711
Database
ISI
SICI code
0256-9574(1998)88:6<706:TIUPE>2.0.ZU;2-6
Abstract
Objective. To review the indications and accuracy of diagnostic thorac oscopy for pleural effusions of unknown origin. Design. Retrospective review of consecutive patients referred for diagnostic thoracoscopy ov er a B-year period from 1 January 1989 to 31 December 1993, Setting, T ertiary referral cardiothoracic unit. Patients, Thirty-four patients r eferred from either medical or oncology services within a university-a ffiliated academic complex. Interventions. All patients had diagnostic thoracoscopy performed under general anaesthesia. Retrospective data were collected in respect of presenting symptoms, gross findings, fina l pathological findings, amount of drainage, length of hospital stay a nd complications of the procedure. In 7 patients (21%), iodised talc w as insufflated at the same time to create pleurodesis. Main results. F inal diagnoses were: 17 (50%) malignant disease, 6 (18%) tuberculosis and 9 (26%) 'negative' pathology. In 2 (6%), further intervention was required to make a conclusive diagnosis. The diagnostic sensitivity fo r malignant disease was 89% and the specificity 100%, For pleural tube rculosis both the sensitivity and specificity were 100%, For 'negative ' diagnoses the negative predictive value was 82%. A history of fever and sweats had a marked association (P = 0.002) with the final diagnos is of tuberculosis. No association could be identified between the gro ss observations at the time of thoracoscopy and the final diagnosis. T he average length of hospital stay was 6.7 (range 1 - 25) days. There was 1 in-hospital death (3%), and 9 patients (26%) had major complicat ions related to the procedure. Conclusions. Diagnostic thoracoscopy is a useful modality for obtaining a diagnosis in effusions of unknown o rigin where other methods have failed. The presence of symptoms such a s fever and sweats is highly associated with a final diagnosis of tube rculosis.