Chest
Clinical InvestigationsPleuroscopy and Pleural Biopsy with the Flexible Fiberoptic Bronchoscope
Section snippets
Materials and Methods
Patients were selected because of undiagnosed pleural disease after the usual studies on pleural fluid and/or needle biopsy with the Abrams needle. One patient was examined because of postoperative bronchopleural fistula after an upper lobe lobectomy for carcinoma of the lung to determine if the resection line was free of tumor. Another patient developed a peripheral pleural-based lesion after nephrectomy for renal cell carcinoma. Pleuroscopic biopsy of the lesion was done for histologic
Case Reports
The following two cases are illustrative of the most common findings in the patients we have examined.
Results
A total of nine patients (Table 1) have been studied by pleuroscopy using the flexible fiberoptic bronchoscope. Seven of the patients had undiagnosed pleural effusions, one had a pleural lesion which appeared three years after nephrectomy for hypernephroma, and one had a postoperative bronchopleural fistula with possible neoplasm in the resection line as the cause of the fistula.
Six of the seven patients with undiagnosed pleural effusion have had a histologic diagnosis of carcinoma, either by
Discussion
Non-thoracotomy methods of obtaining diagnostic material from the pleura have been employed since 1954, and have included partial rib resection,14 limited incisions,15 cutting needles,16, 17, 18, 19, 20, 21 and thoracoscopy.4, 5, 6, 7, 8, 9, 10
Despite several large series demonstrating high diagnostic yields by thoracoscopy,7, 8, 9, 10, 11 the procedure has not been widely utilized. The usual approach to diagnosis of pleural disease has proceeded from thoracentesis with study of pleural fluid
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Cited by (25)
Medical Pleuroscopy
2013, Clinics in Chest MedicineCitation Excerpt :Rigid thoracoscopes allow a large working channel to be maintained but reduce the area of the pleural cavity which is easily accessible, especially if a single entry port is used. Practitioners identified the potential for a more flexible scope early on, with studies experimenting with the introduction of a standard flexible bronchoscope into the pleural space instead of a rigid scope.77,78 The conclusions were that that this adaptation could be made safely and easily but that more satisfactory biopsies were obtained using the standard instrument, perhaps because a lack of proximal rigidity reduces dexterity in the distal portion of the scope.
A modified Abrams needle biopsy technique
1995, Chest
Supported in part by Grant 3-T01-H L05991, National Institutes of Health, and by the Lerrigo Research Fund, Kansas Lung Association.
Manuscript received July 16; revision accepted September 17.