– A fast minimally invasive diagnostic procedure beneficial for pleural fluid drainage, parietal pleural biopsy, and pleurodesis from the chest wall.
A 24 year old woman from Alipurduar who was previously diagnosed to have post streptococcal glomerulonephritis (which is a rare kidney disease) was presented at the Emergency Department of Neotia Getwel Multispecialty Hospital with complains of progressively increasing shortness of breath since 2 weeks. She was evaluated and found to have bilateral pleural effusion (which means build-up of excess fluid between the layers of the pleura of the lungs, in common term – water in the chest). The fluid build-up in the left pleural space of lungs was moderately large and encysted. Diagnostic pleural aspiration was performed on the patient which showed that the fluid was lymphocytic predominant (55%), non hemorhagic and exudative in type. CBNAAT (a test for TB), AFB smear and culture reports were inconclusive, at which point of time, a medical pleuroscopy was performed by Consultant Pulmonologist, Dr.Abhishek Bali on the patient which is a first of its kind medical pleuroscopy procedure performed in the region.
As said by Dr. Abhishek Bali, “During this therapeutic intervention three things were done, which are complete evacuation of the fluid, breakup of the adhesions & pleural biopsy from multiple sites from the parietal pleura .After the procedure the patient was then shifted back to her bed and an ICD tube (Intercostal Drain Tube) was placed at the port of entry for further drainage of the remnant fluid”.
The lungs did not expand immediately after the procedure but the patient improved clinically without the need for continued oxygen supplementation. Her biopsy reports showed presence of granulomatous cells with plenty of AFB (acid fast bacilli) on staining there by confirming a diagnosis of extra pulmonary tuberculosis (tubercular pleural effusion) conclusively. Whereas the previous attempts at diagnosis through conventional techniques like pleural aspiration were inconclusive. She was found to have tuberculosis and thus, was started on Antituberculosis treatment and discharged.
Without performing pleuroscopy it would have been extremely difficult to diagnose the actual cause of the disease in such a scenario and thus pleuroscopy (medical thoracoscopy helped in the faster diagnosis and treatment of the young lady which was efficiently & successfully performed at Neotia Getwel Multispecialty Hospital.