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A retrospective study evaluated the diagnostic performance and safety of medical thoracoscopy in patients with undiagnosed pleural effusion after less invasive testing had not established a cause. Thoracoscopy allowed direct visualization of the pleura and targeted biopsy, producing a high overall diagnostic rate. Malignancy and tuberculosis were among the important final diagnoses, reflecting the clinical complexity of pleural disease in different practice settings. The paper supports an escalation strategy in which persistent, unexplained exudative effusion should not remain in an indefinite cycle of repeat fluid testing when the probability of pleural pathology is high. For HCPs, the practical message is that medical thoracoscopy can bridge the gap between non-diagnostic thoracentesis and more invasive surgical procedures, particularly when tissue diagnosis is needed. Patient selection, local anesthesia or conscious sedation protocols, operator skill, and pathology support remain essential. The findings fit the conference focus on when to escalate to thoracoscopy and on developing a practical pleural algorithm, especially in settings where both malignancy and TB must remain high on the differential diagnosis.
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A retrospective study evaluated the diagnostic performance and safety of medical thoracoscopy in patients with undiagnosed pleural effusion after less invasive testing had not established a cause. Thoracoscopy allowed direct visualization of the pleura and targeted biopsy, producing a high overall diagnostic rate. Malignancy and tuberculosis were among the important final diagnoses, reflecting the clinical complexity of pleural disease in different practice settings. The paper supports an escalation strategy in which persistent, unexplained exudative effusion should not remain in an indefinite cycle of repeat fluid testing when the probability of pleural pathology is high. For HCPs, the practical message is that medical thoracoscopy can bridge the gap between non-diagnostic thoracentesis and more invasive surgical procedures, particularly when tissue diagnosis is needed. Patient selection, local anesthesia or conscious sedation protocols, operator skill, and pathology support remain essential. The findings fit the conference focus on when to escalate to thoracoscopy and on developing a practical pleural algorithm, especially in settings where both malignancy and TB must remain high on the differential diagnosis.
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