The Outcome of Medical Thoracoscopy in Patients with Unexplained Exudative Pleural Effusion

Background: Exudative pleural effusion of unknown etiology is a diagnostic perplexity. Medical thoracoscopy (MT) is a less invasive procedure and has a high diagnostic utility in these patients. Objectives: The study goal was to analyze the value of MT in patients with exudative pleural effusion of unknown cause. Materials and methods: The cross-sectional observational study included clinical data of patients with unexplained pleural effusion of exudative type who had undergone MT at a tertiary care center between July 2019 and June 2022. Results: The diagnostic MT was performed on 28 patients with exudative pleural effusion, which diagnostic thoracentesis could not explain. The diagnostic yield was 96.42%. The mean age was 52.9 +/- 13.5 (range 25-75) years, and 17 (60.7%) were males. Malignancy was diagnosed in 60.70% (17/28) of patients, tuberculosis in 28.60% (8/28) of patients, and nonspecific pleuritis/fibrosis in 10.70% (3/28) of patients. Out of 17 patients with malignancy, metastatic adenocarcinoma was detected in 70.58% (12/17) of patients, malignant mesothelioma in 17.64% (3/17) of patients, and poorly differentiated in 11.76 % (2/17) of patients. No major complications were observed and only three patients had minor complications. Conclusion: Medical thoracoscopy (MT) is a minimally invasive, risk-free, and effective tool for the diagnosis of unexplained exudative pleural effusion with added therapeutic advantages with high diagnostic yield and minimal complication rate.