Chest. 2014 September 4. [Epub ahead of print] [Link]
Marchetti G, Valsecchi A, Indellicati D, Arondi S, Trigiani M, Pinelli V.
Medical Thoracoscopy (MT) is a diagnostic and therapeutic procedure, which permits to study the pleural space. The presence of pleural adhesions is the most important contraindication to performing MT. Lesions of the pleura in absence of pleural effusion are usually studied in video-assisted thoracoscopic surgery (VATS) with preoperative ultrasound evaluation. No data are available about ultrasound guided MT in the absence of pleural effusion.
From January 2007 to June 2013, 622 consecutive MT were performed under US guide, without inducing a pneumothorax. A retrospective cohort of 29 patients affected by pleural diseases with no liquid was reviewed. The 5th-6th intercostals spaces along the midaxillary line with a good echographic ‘sliding sign’ and a normal appearance of the pleural line were chosen as the entry site. Pleural cavity was explored and biopsies were performed.
The mean age of the patient cohort was 62.8 years, 20 male and 9 female. Pleural adherence were avoided, an adequate number of pleural biopsies were performed. We never incurred in parenchymal lung injuries, bleeding or hematoma. 17 patients had a completely free pleural cavity, 4 cases a single pleural adhesion and 8 multiple pleural adhesions but in all cases endoscopic exploration was possible and biopsy adequate. The most frequent histhopathological diagnosis was malignant pleural mesothelioma.
We have shown that thoracic ultrasound is accurate in identify intrathoracic adhesions and in experienced hands can guide medical thoracoscopy access, replacing VATS approach, even in the complete absence of pleural effusion.