1.Drainage of multiloculated tuberculous pleural effusion by medical thoracoscopy: When and why should it be considered?
Sze Shyang KHO ; Swee Kim CHAN ; Mei Ching YONG ; Siew Teck TIE
The Medical Journal of Malaysia 2018;73(1):49-50
Tuberculous pleural effusion (TBE) is a common encounterin our region. Up to 50% of patients with TBE will developresidual pleural thickening (RPT) which can lead tofunctional impairment. However, the need of drainageremains controversial. We report a case of end-stage renalfailure patient who presented with right multiloculatedtuberculous pleural effusion which was drained via amedical thoracoscope. Patient reports immediate relief ofbreathlessness post procedure and one month follow upshown significant improvement of RPT. We also discussedthe current perspective on the rationale of TBE drainage andthe role of medical thoracoscope in TBE management.
2.Diagnostic yield of medical thoracoscopy in exudative pleural effusions in a region with high tuberculosis burden
Sze Shyang KHO ; Swee Kim CHAN ; Mei Ching YONG ; Siew Teck TIE
The Medical Journal of Malaysia 2020;75(3):254-259
Introduction: Pleural effusion is frequently encountered in
respiratory medicine. However, despite thorough
assessment including closed pleural biopsy, the cause of
around 20% of pleural effusions remains undetermined.
Medical thoracoscopy (MT) is the investigation of choice in
these circumstances especially if malignancy is suspected.
The aim of this study is to evaluate the diagnostic yield of
MT in exudative pleural effusions in a single center from
East Malaysia.
Methods: Retrospective chart review of all adult patients
who underwent MT for undiagnosed exudative pleural
effusion in a 24-month duration.
Results: Our cohort comprised of 209 patients with a median
age of 61 years old (IQR 48.5-69.5). There were 92 (44%)
patients with malignant pleural effusion (MPE) and 117 (56%)
benign effusions; which included 85 tuberculous pleural
effusion (TBE) and 32 cases of non-tuberculous exudative
pleural effusion. Conclusive pathological diagnosis was
made in 79.4% of the cases. For diagnosis of MPE, MT had a
sensitivity of 89.1% (95% CI 80.4-94.3), specificity of 100%
(95% CI 96.0-100.0), and positive predictive value (PPV) of
100% (95% CI 94.4-100) and negative predictive value (NPV)
of 92.1% (95% CI 85.6-95.9). For TBE, MT had a sensitivity of
90.5% (95% CI 81.8-95.6), specificity of 100% (95% CI 96.3-
100.0) PPV of 100% (95% CI 94.1-100) and NPV of 93.9% (95%
CI 88.0-97.2). Overall complication rate was 3.3%.
Conclusions: MT showed excellent sensitivity and
specificity in the diagnosis of exudative pleural effusion in
this region. It reduces empirical therapy by providing
histological evidence of disease when initial non-invasive
investigations were inconclusive.