Role of Thoracoscopy in Diagnose of Pleural Effiusion with Unknown Source

ABSTRACT Pleural cffusion is caused by many disease, and also is a symptom of others. There are manys for diagnosis of causes of pleural effusion, such as thoracocentesis and needle biopsy. In about 15 to 20 percent we couldnot find any specific causes, for pleural effusion, and we need more Invasive procedure for definitic diagnosis. such as thoracotomy or thoracoscopy. Today most surgcons rarely use Thoracotomy as the first line invasive procedure for finding the cause of pleural effusion today. Thoracospic evaluation now is more popular. The main goal of this stady is to present the superiority of thoracoscopy than thoracotomy for extensive evaluation of the cause of pleural effusion's. Because of less complication, and more diagnostic Insight and less need thoracotomy. In this study, 40 patients, that had pleural effusion, and we couldnot find the cause of pleural effusion, by Aspiration and necdle biopsy, and thoracopic exam, was performed. In regard to sex of the patients, 28(70%) was male and 12(30%) was female. The mean age was 30 years old, and upper and lower limit was 10-70 years old. Primary diagnosis, was according to clinical finding and 20(50%) patients has pleural cffusion with unknown cause. 8(20%) patients had TB, 6(10%) patients had Empyema and 2(5%) patients had mesothlioma. Thoracopic finding that guide for some disease was: 1 Fluid Aspiiration and direct pleural biopsy in 10 patient 2. Diagnosis of pleural adhesion with fluid aspiration and direct pleural biopsy in 8 patients, 3. TB In 8 Patients. 4.Empyema in 6 patients, 5. Pulmonary metastasis in 4 patients, 6. Mesothelioma in 2 patients,7.Lung mass in 2 patients After tissue sampling and pathologic result, Defintic diagnosis, was as below: 1. TB 28 (70%) 2. Adenocarcinoma metastatic 4(10%) 3. Mesothelioma 3(7.5%) 4. Askin Tumor 2(5%) 5. Squamus cell carcinoma (SCC) of lung 2 (5%) 39(97/5) patients with this mode of evaluation has definitic diagnosis of cause pleural effusion And only in one case thoracotomy was the way for diagnosis. Complications of thoracoscopy was Air leak in 4 (10%), patient's wound infection in 2 (5%) cases with no mortality. Therefore we suggest thoracospic evaluation as The first line for definitic diagnosis, which is the best way for diagnosis before thoracotomy.