ROLE OF EUS IN UNDIAGNOSED PLEURAL EFFUSION

Aims: Background:

Thoracocentesis is the first diagnostic procedure for pleural effusion (PE). If diagnosis after Thoracocentesis remains uncertain, pleural biopsy either CT/USG guided or thoracoscopy is required for definitive diagnosis. Overall, access to thoracoscopy is limited in many parts of the world, as significant resources and expertise are required. We present the data about evaluation of undiagnosed PE by EUS guided pleural aspiration or FNAC of lymph nodes/pleural deposits. This is first case series regarding EUS guided FNAC of pleural deposits.

Methods:

During a period of two years, 11 patients of undiagnosed PE were evaluated by EUS. Aspiration of PE was done if fluid sampling was required and EUS-FNA with rapid on-site evaluation (ROSE) was done if FNAC from PE deposit or lymph node was required.

Results:

7 patients had right sided and 4 had left PE. 3 cases had unsuccessful attempts/complications at US guided aspiration. A single pass was successful in diagnostic aspiration in these cases and the aspirated fluid was suggestive of TB. The remaining 8 cases had non diagnostic aspiration and FNAC with ROSE (average two passes) was done from mediastinal lymphadenopathy or pleural deposits. Four cases with mediastinal lymphadenopathy had granulomatous lesions. Four cases with pleural deposits had malignancy. In this series EUS was selected as the last diagnostic option for three indications: non tappable PE (3 cases), PE with mediastinal nodes (4 cases) and PE with pleural deposits (4 cases).

Conclusions:

EUS guided imaging introduces a totally different path/technique of imaging for inspection of the pleural space. EUS-FNA can be performed as safe procedure in undiagnosed PE. At present it appears that EUS guided evaluation is an alternative modality for evaluation of undiagnosed PE, in the cases who are unfit for thoracoscopy and as an alternative or adjunct to USG/CT guided aspiration or biopsy.