Pleural Procedure

Ginanjar Arum Desianti

 Type
• Closed pleural biopsy
• Open pleural biopsy / medical
thoracoscopy / Pleuroscopy
 Target

x
 Closed pleural biopsy
• Less invasive
• Less budget
• Less diagnostic
 Abrams needle

Cope needle

Jimborean G, Csipor A. Pneumologia. 2017

 Indication

 Malignancy
 Pleurisy
 Pleural plaque
 Other: sarcoidosis, benign
 Caution
 Not cooperative
 Hematology problem
 Anticoagulant drugs
 Critically ill
 Skin lesion
 No pleural space
 Other non invasive procedure is conclusive
 Complication

 Pain
 Pneumothorax
 Hemothorax
Sensitivity
 How to increase diagnostic yield?
• USG guided (widely used)
• CT Guided
• Exudative
• Pleural thickening
• Operator
Tru-cut needle (lesion >24mm)
Open Pleural Biopsy
Rigid vs semi-flex
 Rigid vs semi-flex
• Larger biopsy size • Look and feel = flexible
• Better to control bronchoscope
hemorrhage • Allow suctioning
• Longer duration • Facilitates homogenous
• Easier maintain and insufflation
repair
Rigid vs semi-flex
Indication
 Indication
Diagnostic Therapeutic
• Pleural effusion of • Talc poudrage in malignant
indeterminate origin and chronic or reccurent
• Staging of lung cancer non-malignant pleual
• Pneumothorax effusion
• Diffuse lung disease • Talc poudrage in
pneumothorax
• Corpus alienum
Diagnostic yield
 Contraindication
Absolute Relative
• Advanced empyema • Can not tolerate lateral
• Pleural thickening decubitus
• Previous pleurodesis • Persistent hypoxemia
• Unstable cardiovascular
status
• Bleeding diathesis
• PH
• Druf hypersensitivity
• Bad performance status
 Complication
 Re-expantion pulmonary edema
 Pain, fever, wound infection/empyema
 Hypotension
 Subcutaneous emphysema
 Persisting pneumothorax
 Prolong air leakage
 Continuing pleural fluid production
 Seeding of chest wall by tumor cell
 Mortality