Chest
Volume 90, Issue 4, October 1986, Pages 516-519
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Clinical Investigations
Fiberoptic Bronchoscopy and Pleural Effusion of Unknown Origin

https://doi.org/10.1378/chest.90.4.516Get rights and content

We reviewed our experience with fiberoptic bronchoscopy (FOB) in patients with pleural effusion of unknown origin. Seventy patients underwent FOB for the investigation of pleural effusion between 1978 and 1983. Those with a second reason for FOB, a mass on chest roentgenogram, or lobar atelectasis were excluded. Forty five patients remained: 28 patients with unexplained pleural effusion after pleural fluid analysis and pleural biopsy (UPE), and 17 patients with malignant pleural fluid cytology and/or pleural biopsy but no known primary tumor (MPE). In the UPE group, only one FOB demonstrated malignancy, despite a final diagnosis of tumor in seven. No other specific diagnoses were made by FOB in this group. In the MPE group, FOB demonstrated bronchogenic carcinoma in two; ultimately, five patients were found to have a bronchogenic neoplasm. Although pleural effusion of unknown origin is frequently caused by bronchogenic carcinoma, FOB in the absence of other indications for this procedure is rarely diagnostic and should not be routinely employed.

Section snippets

METHODS

Records of all patients who underwent FOB from 1978 to 1983 by the Brown University Pulmonary Service at the Rhode Island Hospital (RIH) and the Providence VA Medical Center (PVAMC) were reviewed. During the study period, a total of 2,136 procedures was performed at the two hospitals. Pleural effusion was given as an indication in 70 patients. Hospital records and chest roentgenograms were reviewed for these patients. Patients who had an indication for FOB, in addition to pleural effusion such

RESULTS

Clinical characteristics of the 28 patients with UPE and 17 patients with MPE are summarized in Table 1. In the UPE group, all effusions but one were exudates as defined by established criteria.13 The one patient with a transudative effusion was found to have malignant mesothelioma. No patient in this group had a massive pleural effusion, defined as filling more than three quarters of the hemithorax. One effusion was bilateral. Four patients had pleural fluid glucose less than 60 mg/dl.

DISCUSSION

The cause of a pleural effusion can generally be determined by an orderly sequence of clinical and laboratory examinations.14 In the absence of an obvious explanation such as congestive heart failure, a thoracocentesis should be the initial diagnostic procedure. However, a significant number of patients have no diagnosis after pleural fluid analysis. A closed pleural biopsy may then yield additional information leading to a diagnosis. For example, the presence of granulomas on pleural biopsy is

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    Manuscript received January 24; revision accepted April 8.

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