Role of medical thoracoscopy in multiloculated effusions and empyema: Review of 52 cases

OBJECTIVE: Role of medical thoracoscopy in managing multiloculated effusions and empyema is yet to be clearly established. The aim of this study is to report our experience and to analyze the efficacy and safety of this procedure. METHODS: We performed a retrospective analysis of medical records of patients undergoing medical thoracoscopy for multiloculated effusions and empyema at our center under conscious sedation between January 2012 and December 2014. RESULTS: A total of 298 medical thoracoscopies were carried out during the study period. Of these, 52 procedures (42 men, 10 women; mean age: 53.94, range: 23-85 years) were done for multiloculated effusions. Average duration of symptoms before presentation was 13.4 days (range: 2-45). The etiology of effusions included complicated paraneumonic effusions (86.5%) and thoracic trauma (13.5%). The ultrasound characteristics were consistent with free-flowing (3.8%), multiloculated (73%) and organized (23.2%) effusions. Partial adhesionolysis done in 20 (38.5%) and complete adhesionolysis was achieved in 32 patients (61.5%). Streptokinase was instilled into the pleural cavity post procedure in 12 patients (23%). Procedure was successful in 47 patients (90.38%) and 5 patients required decortication. There were 4 complications (2 desaturations, 1 air leak and 1 subcutaneous emphysema) and no mortality. After successful procedure, average time for chest tube removal was 5.46 days (range: 2-17) and time to discharge was 6.95 days (range: 3-20). CONCLUSIONS: Medical thoracoscopy is a safe and effective way to manage multiloculated effusions and empyema. It is a viable, minimally invasive first line alternative before considering decortication.