Vnitr Lek 2006, 52(4):321-327

Medical videothoracoscopy in diagnosis and therapy of pleural effusions

P. Pužman^1,*, M. Teřl¹, P. Mukenšnabl²

¹ Klinika tuberkulózy a respiračních nemocí Lékařské fakulty UK a FN, Plzeň, přednosta prof. MUDr. Miloš Pešek, CSc.

² Ústav patologické anatomie Lékařské fakulty UK a FN, Plzeň, přednosta prof. MUDr. Michal Michal

Videothoracoscopy (VTS) has been performed in the Department of Pneumology in Plzen since the year 2001. Up to September 2005 there were realized 75 videothoracoscopies, all under local anaesthesia with analgosedation and during the spontaneous ventilation. The objective of the present work is to demonstrate that the so called "medical" videothoracoscopy is very well tolerated, quick and accurate miniinvasive method of examination of pleural pathological states, which has a high diagnostic effect and minimal complications. During the exploration it is possible to carry out, besides the collection of bioptic samples from parietal as well as visceral pleura, a whole range of therapeutical acts - evacuation of effusion, mechanical disruption of adhesions in case of empyema with its subsequent drainage or pleurodesis with talc in case of malignant exudates. As for the basic indication of the medical VTS, we consider it to be the differential diagnosis of a pleural effusion of unclear etiology, consisting mostly in the confirmation or exclusion of malignant exudates. The differential diagnosis with the help of VTS between the nonmalignant (mostly inflammatory) and malignant exudate was successful, in our group of patients, in 96 %. The operation was well tolerated by all patients and in none of them occurred significant complications or consequences.

Keywords: videothoracoscopy; medical thoracoscopy; local anaesthesia; pleural pathology; pleural effusion; malignant exudate; differential diagnosis

Received: November 15, 2005; Accepted: January 9, 2006; Published: April 1, 2006  Show citation