Diagnostic and therapeutic pleuroscopy. Experience with 127 patients

Experience with 127 pleuroscopies using the mediastinoscope is reviewed. The most frequent indications were pleural effusion (73 patients), pleural involvement by tumor (14), empyema (14), and recurrent pneumothorax (14). Findings were diagnostic in 119 of 127 patients (93.7 percent). Pleural metastases were found in 63 patients, primary pleural or lung tumor in six, nonspecific or tuberculous empyema in 17, emphysematous blebs in 12 and less common findings in the remainder. Pleuroscopy was usefully employed to determine chest wall penetration by a malignant lung tumor in five patients with severely restricted pulmonary reserve. Positive findings helped to avoid unnecessary thoracotomy. There were two minor complications and no deaths. Malignant pleural effusion causing dyspnea was managed successfully by talc insufflation under direct vision in 35 of 39 patients. Talc was also used, with equal success and without complications, in eight patients with recurrent pneumothorax and in two with empyema after evacuation of pus. We conclude that pleuroscopy is a useful diagnostic and therapeutic procedure, simple and well tolerated, with the diagnostic yield of over 90 percent and virtually free of complications. It provides the best way of insufflating talc for pleurodesis.