الفهرس 
Anatomy of the PleuraOnly 14 pages are availabe for public view
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Abstract
Thoracoscopy has long been established as the procedure of choice in various chest diseases among which is undiagnosed pleural effusions where it allows visualization of the pleural cavity including the diaphragmatic, visceral pleura and the lung. The procedure does not only give information on the extent of the disease itself but also allows adequate tissue biopsy sampling.
The insufflations of talc powder during thoracoscopy are the best conservative method of pleurodesis in malignant and recurrent benign effusions, including chylothorax. Medical thoracoscopy has proved also to be successful in the management of empyema and of spontaneous pneumothorax. In the future it may become even more popular once more respiratory physician are trained in using the procedure.
The aim of the present study was to detect the diagnostic yield of medical thoracoscopy in the diagnosis of exudative pleural effusions of unidentified aetiology.
The current study included 103 patients with unidentified exudative pleural effusion who presented to Abbassia chest hospital retrospectively from January 2010 to November 2011 and prospectively from December 2011 to June 2012. The study was conducted in the endoscopy suite of the respiratory critical care unit in Abbassia chest hospital.
Patients were eligible when they presented with a pleural effusion and had at least one non conclusive diagnostic procedure (e.g: thoracocentesis, closed pleural biopsy).
The enrolled patients were subjected to:
1. Thoracoscopy was performed under local anaesthesia (single entry technique).
2. All apparently abnormal (suspicious) areas seen were biopsied for histopathological examination.
Results showed there were significant association between malignant effusion and living in Helwan due to presence of asbestos factories in residential areas such as Helwan and also presence of other occupational hazards.
The level of LDH and glucose in pleural fluid can be helpful to distinguish between malignant and non malignant pleural effusion as the level of LDH was higher in malignant effusion rather than non malignant effusion, also glucose level was lower in non malignant effusion rather than malignant effusion.
The study showed that presence of lymphocytes and inflammatory cells in pleural fluid is more frequent with non malignant effusion rather than malignant effusion.
Also visualization of the pleura can give a good idea about the nature of the effusion; the thoracoscopic findings in this study revealed that pleural nodularity suggested malignant effusion, while congested pleura and pleural plaques suggested non malignant effusion.