Chest
Clinical InvestigationsFiberoptic Bronchoscopy and Pleural Effusion of Unknown Origin
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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Cited by (45)
Pleural Effusion
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionRecent advances in the diagnosis and management of malignant pleural effusions
2008, Mayo Clinic ProceedingsCitation Excerpt :Most patients who present with undiagnosed pleural effusions benefit from thoracentesis. Although 15% of patients who present with non-small cell lung cancer have an MPE,38 bronchoscopy has a low diagnostic yield in evaluating patients for possible MPE if evidence of a pulmonary parenchymal or airway lesion is lacking.39,40 The selection of a site for thoracentesis has traditionally been guided by chest radiographic and physical findings.41
The role of Abrams percutaneous pleural biopsy in the investigation of exudative pleural effusions
2006, ChestCitation Excerpt :The effect of patient comorbidity on procedure-related complications was not assessed, and further detailed studies are needed to determine the relationship between patient characteristics, radiologic abnormalities, and the incidence of complications. In keeping with other reports,23 this study found that bronchoscopy was not very helpful in the diagnosis of malignant pleural effusion. The practice of performing bedside ultrasonography may serve as a useful adjunct to performing percutaneous pleural biopsy, although this was not available in our study.
Malignancy metastatic to the pleura
1998, Clinics in Chest MedicineInvestigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010
2010, ThoraxCitation Excerpt :In trapped lung syndrome, pleurodesis is likely to be less effective so an indwelling pleural catheter can be placed at the time of VATS (see BTS guideline on thoracoscopy. Bronchoscopy has a limited role in the investigation of patients with an undiagnosed pleural effusion as its diagnostic yield is very low.123–126 It should be reserved for patients whose radiology suggests the presence of a mass or loss of volume or when there is a history of haemoptysis, possible aspiration of a foreign body or a trapped lung with a suspicion of a proximal lung mass.
Manuscript received January 24; revision accepted April 8.
Read before the annual meeting of the American Thoracic Society, Anaheim, CA, May 1985