CLINICO-HISTOPATHOLOGICAL CHARACTERISTICS OF UNDIAGNOSED PLEURAL EFFUSION PATIENTS UNDERGOING MEDICAL THORACOSCOPY IN A TERTIARY CARE CENTRE OF SOUTHERN RAJASTHAN
Main Article Content
Keywords
Pleural effusion, Medical thoracoscopy, Histopathology, Malignant effusion, Tubercular effusion, Diagnostic yield
Abstract
Pleural effusion remains a common clinical problem with diverse etiologies, including malignancy and tuberculosis. Despite routine diagnostic investigations such as pleural fluid cytology, biochemical testing, and imaging, approximately 20–25% of cases remain undiagnosed. Medical thoracoscopy provides direct visualization of pleural pathology and targeted biopsy, improving diagnostic accuracy. Limited regional data exist regarding its diagnostic utility in Southern Rajasthan.
Aim: To evaluate the clinico-histopathological characteristics and diagnostic yield of medical thoracoscopy in patients with undiagnosed pleural effusion.
Methods: This prospective observational study was conducted over four months (June–September 2025) at a tertiary care center in Southern Rajasthan. A total of 47 adult patients with exudative pleural effusion of unknown etiology after standard evaluation underwent medical thoracoscopy. Clinical presentation, radiological findings, thoracoscopic morphology, pleural fluid biochemistry, and histopathological outcomes were recorded. Statistical analysis included Chi-square and ANOVA tests, with a p-value <0.05 considered significant.
Results: A definitive histopathological diagnosis was achieved in 45 of 47 cases, yielding a diagnostic accuracy of 95.7%. Malignant pleural effusion was the most common etiology (57.4%) with adenocarcinoma metastasis being predominant, followed by mesothelioma. Tuberculosis accounted for 36.2% of cases and was the leading non-malignant cause. Malignant effusion patients were significantly older than non-malignant cases (p=0.0245). Fever (p=0.0002) and shorter illness duration significantly correlated with tuberculosis, while chest pain (p=0.0104) and massive effusion were more associated with malignancy. Thoracoscopic findings such as nodules (p=0.0001) favored malignancy, whereas sago-like nodules, adhesions, fibrinous deposits, and pleural thickening were significantly associated with tubercular effusion. Pleural fluid analysis revealed significantly higher LDH levels in malignancy (p<0.0001) and elevated ADA in tuberculosis (p<0.0001). Lymphocyte predominance was observed in both etiologies and was not statistically significant.
Conclusion: Medical thoracoscopy proved to be a safe and highly effective diagnostic tool for undiagnosed pleural effusion, particularly in distinguishing between tuberculosis and malignancy. Its integration into diagnostic algorithms may reduce delays and improve clinical outcomes.
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Dr Virendra Singh Dodiyar
Post Graduate Student, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Mahesh Kumar Mahich
Assistant Professor, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Neha Damor
Assistant Professor, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Manoj Kumar Arya
Assistant Professor, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Mahendra Kumar Bainara
Senior Professor, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Ved Prakash Sharma
Post Graduate Student, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Jatin Prajapati
Senior Resident, Department of Community Medicine, World College of Medical Sciences and Research, Jhajjar, Haryana, India, ORCID: https://orcid.org/0009-0004-7298-4499
