The safety, outcomes, and prognostic factors associated with medical thoracoscopy
R. Ronaghi*a (Dr), M. Ueokab (Dr), R. Garciab (Dr), C. Obergb (Dr), T. Heb (Dr), I. Susantob (Dr), C. Channickb (Dr), S. Ohb (Dr)
a UCLA, Pacific Palisades, UNITED STATES ; b UCLA, Los Angeles, UNITED STATES
* rronaghi@gmail.com
Pleuroscopy is usually used for fluid drainage, biopsy, diagnosis and pleurodesis. There has been very little data on the use of pleuroscopy for the treatment of parapneumonic and empyema. In our study we looked at the overall outcomes in our pleuroscopy cases, and to look at their use in parapneumonic and empyema. We also look at fluid characteristics that can potentially lead to complex pleural spaces.
A total of 178 patients who underwent pleurosocpy in 24 months were enrolled retrospectively in the study. Data was collected in Excel including demographics, need for pleuroscopy, final diagnosis, outcomes, pleural fluid study before the procedure and complications. Data was analyzed using SPSS software.
Of the 178 patients, 111 were malignant effusion. Overall diagnostic yield was 100%, and success for pleurodesis was 97%. The most common diagnosis was lung adenocarcinoma. 36 patients had parapneumonic or empyema. 31 were for benign causes. Of the 36 infected patients, 26 had empyema, and 10 had parapneumonic effusion. 35/36 patients required no further procedure after the pleuroscopy and wash out and were discharged from the hospital. Of all patients, a WBC count over 3204, neutrophil count above 32%, lymphocyte count over 72%, protein count over 3.6 and LDH over 164 was associated with a complex pleural space. Time between thoracentesis and development of a complex pleural space in the above patients was an average of 22.4 days. There were no complications and no mortality.
This is the largest study of its kind that shows the safety and outcome in pleuroscopy. This study also shows that pleuroscopy can be done safely and with great outcomes in patients with empyema. This is the first study to also suggest that timing from thoracentesis to pleuroscopy can be important in certain patient populations with an exudative effusion, suggesting a more aggressive approach.
Disclosure of funding source(s): none