2019 Volume 41 Issue 6 Pages 569-573
Background. Thoracoscopy under local anesthesia is a useful tool for diagnosing pleural effusion with a reportedly high diagnostic rate; however, there are limited reports regarding its usefulness and safety in patients with undiagnosed pleural effusion despite thoracentesis or a closed pleural biopsy. Objective. To evaluate the usefulness and safety of thoracoscopy under local anesthesia for diagnosing pleural effusion that has gone undiagnosed despite thoracentesis or a closed pleural biopsy. Methods. We retrospectively evaluated the clinical characteristics, diagnosis based on thoracoscopy under local anesthesia, diagnostic rate, and complications among patients with undiagnosed pleural effusion who had undergone thoracoscopy under local anesthesia at the Japanese Red Cross Wakayama Medical Center between January 2012 and December 2018. No cases had been diagnosed by thoracentesis before thoracoscopy. Results. Of the 50 patients (men: 39, median age: 72.5 years), carcinomatous pleurisy was diagnosed in 14 (28%), malignant mesothelioma in 11 (22%), benign asbestos pleurisy in 10 (20%), tuberculous pleurisy in 2 (4%), non-tuberculous mycobacterium pleurisy in 1 (2%), rheumatoid pleurisy in 1 (2%), empyema in 1 (2%), hepatic pleural effusion in 1 (2%), drug-related pleural effusion in 1 (2%), and cases of indeterminate origin in 8 (16%). The diagnostic rate of thoracoscopy was 84%. Complications associated with thoracoscopy included 5 (10%) patients with subcutaneous emphysema and 2 (4%) patients with postoperative empyema. All 7 patients recovered with treatment, and no deaths were registered within 1 month after thoracoscopy. Conclusion. Thoracoscopy under local anesthesia is a useful and safe diagnostic tool for diagnosing as-yet-undiagnosed pleural effusion.
