Pleuroscopy for Diagnosis and Treatment of Pleural Effusions

A pleuroscopy is a medical procedure in which doctors can examine the pleural cavity, the space between the two layers of tissue (the pleura) that line the lungs. This procedure is performed in an operating suite or room with anesthesia and is considered minimally invasive. A pleuroscopy may be done after a thoracentesis (a less invasive procedure to remove fluid from the pleural space) as a diagnostic procedure when abnormalities of the pleura are suspected, or as a treatment to remove fluid, or to perform a pleurodesis (a surgical procedure designed to eliminate the pleural space). A pleuroscopy is usually well-tolerated but is subject to risk of infection, bleeding, or injury to chest organs similar to other surgical procedures.

A pleuroscopy may be used for either making a diagnosis or to address a buildup of fluid in the pleural space. Some of the reasons for a pleuroscopy include the following.

• To visualize the pleura for any abnormalities (for example, to look for evidence of cancer of the pleura (mesothelioma) or lung cancers that extend to the pleura. Metastatic cancer to the lungs such as breast cancer may also be detected.
• To take a sample of fluid from a pleural effusion to look for infection or cancerous cells in the fluid. A malignant pleural effusion is a pleural effusion which contains cancerous cells. This is done through attaching a vacuum to the end of the tube to withdraw fluid.
• To take a biopsy of the pleura or the lungs.

• To do a pleurodesis: This is a procedure in which a chemical is inserted into the pleural cavity causing the two layers of pleura (the parietal pleura and the visceral pleura) to become inflamed and stick together. Once this occurs fluid is unable to recollect in the pleural space. A pleurodesis may be indicated if there is rapidly recurring, malignant pleural effusion, or recurring pneumothorax.

During a pleuroscopy, a tube called a pleuroscope is inserted into the pleural cavity through a small incision in the chest wall. The physician, under sterile technique, will first numb the skin through which the tube will be inserted. You may be given local anesthesia, but most commonly this procedure is performed while you are asleep in the operating suite.

With the help of a special camera at the end of the tube, your doctor can then visualize the pleural cavity to look for any abnormalities. They can take samples (biopsies) if needed, sample and drain fluid (if needed) and for those with recurrent pleural effusions, can insert a chemical that causes the linings of the lungs to stick together, a procedure called pleurodesis.

The risk of a pleuroscopy is relatively low, with complications occurring in only 2 to 5% of people. Some of these complications may include:

• Bleeding from the tube insertion site or within the chest
• Infection
• A pneumothorax (collapse of a lung)
• Pain
• Injury to organs in the chest cavity

The risk of complications can vary based on the location being biopsied, the underlying medical condition being evaluated, and other medical problems the patient has.

Your surgeon will let you know after the procedure if they find anything that appears abnormal. If you have a buildup of fluid, they will let you know how successful the procedure was in removing this fluid. If a sample of the effusion was taken to look for cancerous cells, you may have to wait until a pathologist has a chance to look at this in the lab.

While a pleuroscopy is a relatively low-risk procedure from a physician's standpoint, it can be frightening if the procedure is recommended. It's important to talk to your doctor about why exactly the test is being recommended (what do they hope to find or rule out), whether there are alternatives to the procedure, what side effects you may expect, and potential complications of which you should be aware.