• Emad Ibrahim, Essam Hassanein, Eman Hatata, Suzan Helal, and Ayman Baess.
• Chest. 2014 Mar 1;145(3 Suppl):289A.

Session TitlePleuralSESSION TYPE: Slide PresentationsPRESENTED ON: Sunday, March 23, 2014 at 04:15 PM - 05:15 PMPURPOSE: Study objective: To evaluate the role of rigid medical thoracoscopy in the management of patients with undiagnosed exudative pleural effusion.MethodsDesign: Prospective study. Setting: Alexandria university. Subjects: Sixty patients with undiagnosed exudative pleural effusion. Methods: Medical thoracoscopy.All included patients were subjected to medical thoracoscopy using rigid scopes for either diagnostic purposes or both diagnostic and therapeutic purposes.ResultsThe current study enrolled 60 patients with symptomatic undiagnosed exudative pleural effusion. Medical thoracoscopy using rigid non-disposable, re-sterilizable instruments was performed in all studied patients for diagnostic and/or therapeutic purposes. The mean age was 53.9 years (SD 13.9 years). Forty-eight (80%) patients lied in the age group between 40 and 80 years. The number of male patients was 36 (60%) while 24 (40%) patients were females. Pleural nodules were the commonest lesions detected as 37 (61.7%) patients. Pleural plaques were found in 24 (40%) patients, pleural masses in 6 (10%) patients, focal pleural thickening in 10 (16.7%) patients and pleural peel in 20 (33.3%) patients. There was significant positive correlation between the pleural nodules and the occurrence of complications (X2=4.435, p=0.037). Adhesions inside the pleural space during thoracoscopy, 24 (40%) patients were adhesion-free "grade 0". Adhesions were grade 1 in 15 (25%) patients, grade 2 in 9 (15%) patients, grade 3 in 11 (18.3%) patients and grade 4 in a single patient. Pleural biopsy was of benign nature in 21 (35%) patients (TB pleuritis in 7 (11.7%) patients and non-specific pleurisy (NSP) in 14 (23.3%) patients), while malignant pleural biopsy was diagnosed in 39 (65%) patients (Bronchial carcinoma in 16 (26.7%) patients , malignant mesothelioma in 7 (11.7%) patients, metastasis from cancer ovary in 3 (5%) patients, cancer breast in 2 (3.3%) patients, adenocarcinoma of unknown primary in 8 (13.2%) patients and other malignancies in 3 (5%)patients. Thoracoscopic therapeutic interventions succeeded in 22 (88%) patients and failed in 3 (12%) patients.ConclusionsRigid Medical thoracoscopy in the hands of pulmonologists is generally safe, cheap, and highly effective in obtaining a histopathological diagnosis.Clinical ImplicationsMedical thoracoscopy is an important diagnostic tool for the chest physician at hospitals where patients can not afford expensive surgical VATS and at the same time results are conclusive.DisclosureThe following authors have nothing to disclose: Essam Hassanein, Eman Hatata, Suzan Helal, Emad Ibrahim, Ayman BaessNo Product/Research Disclosure Information.

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