الفهرس 
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Abstract
This prospective, observational, and cross-sectional study over a period of 2 years (from January, 2021 to January 2023), included 164 patients with pleural effusion who attend to chest department, Minia cardio-thoracic university hospital.
The main aim of the study is to evaluate cases of pleural effusion and the diagnostic value of fiberoptic bronchoscopy and thoracoscopy in patients with unexplained pleural effusion
All Patients were assessed as regards the:
• Full medical history taking.
• Clinical examination and assessment of blood pressure, pulse rate and oxygen saturation.
• Investigations:
(1) Chest X-ray (postro-anterior and lateral views).
(2) Recent Computed Tomography (CT) of the chest with contrast.
(3) Chest Ultrasound with color Doppler.
(4) Full routine laboratory investigations: Complete blood picture, liver and kidney functions and ESR.
(5) Coagulation profile (Including prothrombin time, concentration and INR).
(6) Thoracentesis was sent for chemical (Sugar, total protein, LDH), ADA if indicated, Bacteriological examination (Gram stain, culture and sensitivity) and cytological examination (predominate cells).
(7) Additional examinations were performed according to the clinical findings, including Echocardiography, mammography, gynaecological examination, digestive tract endoscopy, abdominal ultrasonography, abdominal (CT) scan, biopsy of the pulmonary mass, liver or lymph nodes.
(8) Medical thoracoscoy was done if no obvious cause after all those investigations.
(9) FOB was done if patients had hemoptysis or radiological signs indicating a malignant tumor, such as a mass or a large pleural effusion with a shift in the midline to the effusion’s side.
The study shows that the mean age of the patients was 55.77 with a range of 20-88; the majority of them were males 101 (61.6%) and females 63 (38.4%).74 cases (45.1%) had right-sided pleural effusion, 59 cases (36%) had left-sided pleural effusion, and 31 cases (18.9%) had bilateral pleural effusion. In terms of pleural fluid color, 122 (74.4%) patients were yellowish, whereas 42 (25.6%) had hemorrhagic pleural effusion. In terms of pleural fluid appearance, 108 cases (65.9%) had turbid pleural effusion, 34 (20.7%) had clear pleural effusion, and 22 (13.4%) had pus. The most common type of pleural effusion is lymphocytic exudate. There were 85 cases (51.8%) of malignancy, 24 cases (14.6%) of empyema, 12 cases (7.3%) of tuberculosis, 12 cases (7.3%) of parapneumonic disease, 3 cases (1.8%) of autoimmune disease, and 5 cases (3%), which remained undiagnosed. The etiology of transudative pleural effusion was found to be 4 (2.5%) hypoalbuminemia, 5 (3.1%) liver failure, and 14 (8.5%) cardiac failure. The primary tumor associated with malignant effusion were lung cancer (47.1%), mesothelioma (11.7%), breast cancer (9.5%) , Gastrointestinal cancer (4.7%), and lymphomas (4.7%) , others (4.7%), cancer ovary (3.5%) and unknown (14.1%) of cases. When comparing malignant and non-malignant group, malignant group were older, presented with toxic symptoms, clubbing, enlarged lymph nodes significantly more among malignant group than non-malignant and with elevated ESR. Malignant group had hemorrhagic, turbid effusion with increased pleural protein and presence of atypical cells much more than non -malignant group. Pleural nodules seen by Ultrasonography were found more in malignant effusion with specificity of 96.2%.
Medical thoracoscopy was done in 61 (37.5%) of cases. The diagnostic yield of medical thoracoscopy was 95%. Our thoracoscopic biopsy results clearly revealed that malignancy was diagnosed in 47 (77%) of patients, 9 (14.8%) were due to tuberculosis, 3(4.9%) undiagnosed, 1(1.6%) was due to empyema, and 1(1.6%) was Inflammation / autoimmune.
No serious adverse events related to the procedure were observed in the current study. Surgical emphysema was developed in 10 (16.4%) of patients.
In the present study, FOB was done in 17 cases with a suspicious endobronchial lesion or parenchymal abnormalities. FOB could reach a diagnosis in 15 out of 17 selected cases. Findings observed in bronchoscopy were endobronchial growth, mucosal abnormalities and external compression. As regards FOB biopsy results, 8 cases had Adenocarcinoma, 5 cases had Squamous cell carcinoma, 2 cases had Small cell carcinoma, and 2 cases had Non-specific inflammation.