Table 1: Diagnosis of Malignant Pleural
Effusion [2,4,7].
1 |
Chest X-ray - identification of effusion |
2 |
CT scan - can identify parenchymal disease, metastasis,
LN involvement |
3 |
Ultrasound - can identify pleural lesions and
adhesions, assist with thoracentesis |
4 |
MRI - limited benefit, evaluate for chest wall
involvement |
5 |
Diagnostic thoracentesis-
nucleated cell count and differential, total protein, lactate dehydrogenase, glucose,
pH, amylase and cytology. a) Complications:
pneumothorax, bleeding, infection, spleen or liver laceration. b) Relative
contraindications: minimal effusion (less than 1 cm in thickness from fluid
level to chest wall), bleeding diathesis, anticoagulation and mechanical
ventilation. |
6 |
Closed pleural biopsy - less sensitive than pleural
fluid cytology a) Low
yield: Distribution of tumor in areas not sampled by blind biopsy, operator
inexperience, early stage disease with minimal pleural involvement. b) Contraindication:
bleeding diathesis, anticoagulation, chest wall infection, lack of patient
cooperation. c) Complications:
pneumothorax, hemothorax, vasovagal reaction. |
7 |
Medical Thoracoscopy - direct
visual control with thoracosope or indirectly by
video. a) Indication:
evaluation of exudative effusion of unknown cause, staging, biopsy, treatment
with pleurodesis. |
8 |
Bronchoscopy - low yield. Used to exclude endo-bronchial obstruction, especially before pleurodesis if lung does not re-expand after thoracentesis. |
9 |
Surgical Biopsy a) Video
Assisted Thoracic Surgery ·
Contraindication:
mechanical ventilation, prior contralateral pneumonectomy,
operator inexperience, pleural space adhesions b) Open
biopsy |