The accurate diagnosis of pleural diseases can present a considerable challenge. Conservative estimates suggest that in 25% of patients examined in a general pulmonologist’s practice the pleura was involved. Of these cases, 25% are unable to be attributed to a specific diagnosis, even after thoracentesis and closed pleural biopsy. The aim of this work was to evaluate the diagnostic role of medical thoracoscope in undiagnosed exudative pleural effusion and to compare the diagnostic yield of rigid versus flexible (the fibreoptic bronchoscope used as a thoracoscope) thoracoscopy.

Forty patients with exudative pleural effusion of undetermined aetiology were enrolled in this study. Ethics: the study was approved by the institutional ethics committee and each patient gave an informed consent to participate in the study. Under conscious sedation and local anaesthesia, both rigid and flexible thoracoscopy were carried out using fibreoptic bronchoscope as a flexible thoracoscope inserted through a metal trocar. The pleural cavity was carefully explored and multiple forceps biopsies were equally taken with both types of thoracoscopes and sent for both histopathological and microbiological examinations.

All thoracoscopy procedures were performed safely. The diagnostic yield of flexible thoracoscope and that of rigid thoracoscope was 80% (32/40) and 95% (38/40), respectively.

Thoracoscopy using either fibreoptic bronchoscope or rigid thoracoscope is safe and well tolerated. Rigid thoracoscope has a higher diagnostic yield, easier handling, better orientation and is less expensive. Nevertheless, fibreoptic bronchoscope is an alternative technique if rigid thoracoscopy is not available.