Ultrasound-assisted medical thoracoscopy

Abstract Introduction Medical thoracoscopy is an important tool for the diagnosis and management of several pleural diseases. The presence of fibrous pleural adhesions may prevent medical thoracoscopy to access the pleural space properly, which may lower the diagnostic yield of the procedure and may also increase the risk for associated complications. The role of on-table chest ultrasound (US) before medical thoracoscopy is investigated in this study. Aim of the study The aim of this study was to evaluate the utility of on-table chest US before medical thoracoscopy and its ability to locate a safe point of entry, its impact on the facility of the procedure, and the risk for complications. Patients and methods Forty patients who underwent medical thoracoscopy for investigation of undiagnosed pleural effusion were included in this study. They were randomized into two groups. In group I, chest US was performed on table immediately before medical thoracoscopy and in group II, no chest US was performed. Results Computed tomography chest detected pleural adhesions in one patient (5%) in group I and in two patients (10%) in group II, whereas medical thoracoscopy detected five patients (25%) in group II and six patients (30%) in group I. Chest US was able to detect all cases with pleural adhesions in group I. Four patients (20%) in group II needed extra procedures to access the pleural cavity due to unsuccessful primary point of entry, and two (10%) had complications in the form of bleeding. All patients in group I had successful access to the pleural cavity with no needed extra procedures and no complications. The mean duration of the procedure in group I was 42 ± 5.4 versus 50 ± 10.4 min in group II. Conclusion Chest US performed before medical thoracoscopy can facilitate the procedure; it reduces the unsuccessful attempts to access the pleural cavity, minimizes the risk for complications, and reduces the duration of the procedure.