Flexible fiberoptic pleuroscopy: pleural and lung biopsy

While diagnostic procedures are available to explore most of the body cavities for diagnosis and treatment, examination of the pleural cavity remains difficult, mainly because the negative pressure in the pleural cavity makes direct examination impossible without collapsing the lung. The ability to diagnose pleural and pulmonary disease by conventional techniques, such as blind pleural and lung biopsy, cytology of bronchial washings and brushings, radiologic techniques or cultures is limited and frequently fails to provide an accurate diagnosis. Exploratory thoracotomy, with a relatively high complication rate, remains the method of choice in many cases. We have devised a new technique for exploring the pleural cavity under direct vision while avoiding lung collapse, using a modified flexible fiberoptic bronchoscope introduced into the pleural cavity through a specially designed cannula.