, Volume 168, Supplement 1, pp 1113–1121 | Cite as

The role of thoracoscopy in the evaluation and management of pleural effusions

  • C. Boutin
  • Ph. Astoul
  • B. Seitz
Endoscopy, Biopsy Techniques In Pleural Diseases


Diagnostic thoracoscopy is indicated in every patient where the usual investigations (including biochemistry, cytology, bacteriology, occasionally needle biopsy of the pleura) do not achieve a precise diagnosis. The percentage of so-called “idiopathic” effusions, amounting to approximately 20% in many published series, can be reduced to 4% after thoracoscopy. The sensibility of thoracoscopic biopsy reaches 93–97% of malignant or tuberculous pleural effusions. The procedure requires a short hospitalization of about 36 hr, and complications are rare.

Therapeutic thoracoscopy is frequently performed in chronic, malignant, recurrent effusions in order to achieve a pleurodesis by means of a talc poudrage under visual control. The efficacy of the poudrage in the published randomized studies is better than tetracycline. About 90% of patients are cured, the effusion being totally suppressed. Side effects are rare if the quantity of talc does not exceed 10 ml.

Key words

Thoracoscopy Exudate Pleural effusion Mesothelioma Tuberculous effusion Pleurodesis Talc poudrage 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Boutin C, Viallat JR, Cargnino P, Farisse P (1981) Indications actuelles de la thoracoscopie. Rev Fr Mal Resp 9:309–318Google Scholar
  2. 2.
    Boutin C (1975) Aspects actuels des pleurésies tuberculeuses. Med Hyg 33:1365–1369Google Scholar
  3. 3.
    Martensson G, Pettersson K, Thiringer G (1985) Differentiation between malignant and non-malignant pleural effusion. Eur J Resp Dis 67:326–334Google Scholar
  4. 4.
    Boutin C, Viallat JR, Cargnino P, Farisse P, Irisson M, Rey F, Velardocchio JM (1985) Thoracoscopy. In: Chretien J, Bignon J, Hirsch A (ed) The Pleura in Health and Disease Vol 30. M. Dekker, New York, pp. 587–622Google Scholar
  5. 5.
    Levine MN, Young JE, Ryan ED, Newhouse MT (1986) Pleural effusion in breast cancer. Thoracoscopy for hormone receptor determination. Cancer 57:324–327PubMedCrossRefGoogle Scholar
  6. 6.
    Boutin C, Cargnino P, Viallat JR (1980) Thoracoscopy in the early diagnosis of malignant pleural effusions. Endoscopy 12:155–160PubMedCrossRefGoogle Scholar
  7. 7.
    Migueres J, Jover A, Cantegril A, Girard JJ (1974) Intérêt de la ponction biopsie pleurale à l’aiguille dans le diagnostic des pleurésies non purulentes (à propos de 250 épanchements). Rev Med Toulouse 10:387Google Scholar
  8. 8.
    Canto A, Rivas J, Saumench J, Morera R, Moya J (1983) Points to consider when choosing a biopsy method in cases of pleurisy of unknown origin. Chest 84:176–179PubMedCrossRefGoogle Scholar
  9. 9.
    Collins TR, Sahn SA (1987) Thoracocentesis. Clinical value, complications, technical problems, and patient experience. Chest 91:817–822PubMedCrossRefGoogle Scholar
  10. 10.
    Salyer WR, Eggleston JC, Erozan YS (1975) Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. Chest 67:536–539PubMedCrossRefGoogle Scholar
  11. 11.
    Dines DE, Pierre RV, Franzen SJ (1975) The value of cells in the pleural fluid in the differential diagnosis. Mayo Clin Proc 50:571–572PubMedGoogle Scholar
  12. 12.
    Graham GG, McDonald JR, Glagett OT, Schmidt HW (1953) Examination of pleural fluid for carcinoma cells. J Thorac Surg 25:366–370PubMedGoogle Scholar
  13. 13.
    Wihlm JM, Roeslin N, Morand G, Pauli G, Witz JP (1981) Résultats comparés de la ponction, de la biopsie à l’aiguille, de la pleuroscopie et de la thoracotomie dans le diagnostic des pleurésies chroniques. Poumon-Coeur 37:57–60PubMedGoogle Scholar
  14. 14.
    Faurschou P, Francis D, Faarup P (1985) Thoracoscopic, histological, and clinical findings in nine case of rheumatoid pleural effusion. Thorax 40:371–375PubMedCrossRefGoogle Scholar
  15. 15.
    Chahinian AP (1983) Therapeutic modalities in malignant pleural mesothelioma. In: Chretien J, Hirsch A (eds) Diseases of the pleura. Masson Edit., pp 224–236Google Scholar
  16. 16.
    Fentiman IS, Rubens RD, Hayward JL (1986) A comparison of intracavitary talc and tetracycline for the control of pleural effusions secondary to breast cancer. Eur J Cancer Clin Oncol 22:1079–1081PubMedCrossRefGoogle Scholar
  17. 17.
    Boutin C, Rey F, Viallat JR (1985) Etude randomisée de l’efficacité du talcage thoracoscopique et de l’instillation de tétracycline dans le traitement des pleurésies cancéreuses récidivantes. Rev Mal Resp 2:374Google Scholar
  18. 18.
    Muir JF, Cerisel F, Defouilloy C, Broussier PM, Hermant A, Aubry P, Noarurinze S, Botto JM, Arlati S (1987) Pleural drainage with talc vs Doxycycline in the control of malignant pleural effusions. Am Rev Respir Dis 135:A244Google Scholar
  19. 19.
    Frankel A, Krasna I, Baronofsky ID (1961) An experimental study of pleural symphysis. J Thorac Cardiovasc Surg 42:43–51PubMedGoogle Scholar
  20. 20.
    Sahn SA, Good JT (1981) The effect of common sclerosing agents on the rabbit pleural space. Am Rev Respir Dis 124:65PubMedGoogle Scholar
  21. 21.
    Tomlinson JR, Sahn SA (1986) Treatment of pleural effusion. Chest 89:470–471PubMedCrossRefGoogle Scholar
  22. 22.
    Ostrowski MJ (1986) An assessment of the long-term results of controlling the reaccumulation of malignant effusions using intracavitary bleomycin. Cancer 57:721–727PubMedCrossRefGoogle Scholar
  23. 23.
    Gravelyn TR, Michelson MK, Gross BH, Sitrin RG (1987) Tetracycline pleurodesis for malignant pleural effusions. A 10-Year retrospective study. Cancer 59:1973–1977PubMedCrossRefGoogle Scholar
  24. 24.
    Dunkel TB (1986) Intrapleural tetracycline in the treatment of malignant pleural effusions. Minnesota Med 69:717–725PubMedGoogle Scholar
  25. 25.
    Wooten SA, Strange C, Barbarash R, Sahn SA (1987) Pharmacokinetics of tetracycline and lidocaine following intrapleural instillation. Am Rev Respir Dis 135:A 245Google Scholar
  26. 26.
    Shelbalkar AR, Head JM, Head LR, Murphy DJ, Mason JH (1971) Evaluation of talc pleural symphysis in management of malignant pleural effusion. J Thorac Cardiovasc Surg 61:492–497Google Scholar
  27. 27.
    Rinaldo JE, Owens GR, Rogers RM (1983) Adult respiratory distress syndrome following intrapleural instillation of talc. J Thorac Cardiovasc Surg 85:523–526PubMedGoogle Scholar
  28. 28.
    Bouchama A, Chastre J, Gaudichet A, Soler P, Gilbert C (1984) Acute pneumonitis with bilateral pleural effusion after talc pleurodesis. Chest 86:795–797PubMedCrossRefGoogle Scholar
  29. 29.
    Todd TRJ, Delarue NC, Ilves R, Pearson FG, Cooper JD (1980) Talc poudrage for malignant pleural effusion. Chest 78:542–543Google Scholar
  30. 30.
    Bethune N (1935) Pleural poudrage. A new technic for the deliberate production of pleural adhesions as a preliminary to lobectomy. J Thorac Cardiovasc Surg 4:251–261Google Scholar
  31. 31.
    Churg A, Warnock ML, Bensch KG (1978) Malignant mesothelioma arising after direct application of asbestos and fiber glass to the pericardium. Am Rev Respir Dis 118:419–424PubMedGoogle Scholar
  32. 32.
    Leophonte P, Basset MF, Pincemin J, Louis A, Fernet P, Delaude A (1983) Mortalité des travailleurs du talc en France. Rev Fr Mal Resp 11:489–490Google Scholar

Copyright information

© Springer-Verlag New York Inc 1990

Authors and Affiliations

  • C. Boutin
    • 1
  • Ph. Astoul
    • 1
  • B. Seitz
    • 1
  1. 1.Hôpital la ConceptionMarseille Cedex 5France

Personalised recommendations