The Diagnostic Value Of Medical Thoracoscopy In Pleural Effusions Of Undetermined Etiology

Objective:To evaluate the diagnostic value of medical thoracoscopy(MT) in pleural effusions of undetermined etiology,and to explore the endoscopic features in Pleural Effusions of different etiology.Methods:We retrospective analyse the clinical feature and visual finding of 221 patients who performed medical thoracoscopy in the First Affiliated Hospital of Guangxi Medical University from August 2012 to December 2014 for unexplained pleural effusion.Results:1.Of the 221 patients,133 patients were diagnosed as pleural tuberculosis,60 were malignant,2 were fungous,30 were non-specific pleuritis.The sensitivity for pleural tuberculosis is 97.1%,while for malignant pleural effusions is 93.3%;2.For the visual finding under medical thoracoscopy we found that the presence of pleural necrosis and adhesions or fibrotic septa was significantly associated with the likelihood of tuberculosis,while the presence of pleural masses(>3cm) and single or multiple pleural nodules(> 5 mm and<3cm)was significantly associated with the likelihood of malignancy;3.The two case of Pleural Effusions due to penicillium marneffei was confirmed by the means of pleural tissue culture or pathology,the endoscopic findings of pleural effusions due to penicillium marneffei showed adhesions or fibrotic septa,and one also showed multiple pleural nodules;4.There were 30 cases whose pleural tissue pathology were non-specific pleuritis,the final diagnose were four malignant, four were tuberculosis,12 were parapneumonic,1was hepatic,9 were idiopathic.the false negative rate for malignant pleural effusions was 13.3%.Conclusion:Medical thoracoscopy has an important application value in the diagnosis of unexplained pleural effusion. The visual finding under medical thoracoscopy can help diagnose the etiology of pleural effusion. P. Marneffei infection with pleural effusion can be diagnosed by the culture of specimens obtained by medical thoracoscopy.The majority of cases diagnosed as non-specific pleuritis adopt a benign course.