Augmented Fluoroscopy for Guidance of Bronchoscopic Biopsy of Pulmonary Nodules: Best of Both Worlds?

to calretinin, WT1, and D2-40, and revealed negative reactions to CEA and TTF-1. We consequently diagnosed epithelioid pleural mesothelioma. The next day, the chest radiograph showed well-expanded right lung. Medical thoracoscopy is a minimally invasive single-port endoscopic technique that provides direct visualization of the pleural surface and allows for both diagnostic and therapeutic procedures.2 Its utility, however, is limited when fibrous adhesions are substantial.2 In fact, based on British Thoracic Society guidelines, lungs adherent to the chest wall throughout the hemithorax is an absolute contraindication to this procedure.3 Many reports, however, have focused on the efficacy of using fibrinolytic agents to break down pleural loculations, primarily in the setting of pleural infection. Furthermore, several small series have also reported the use of intrapleural fibrinolysis for the management of loculated malignant effusions.1,4,5 The application of intrapleural urokinase directly through a medical thoracoscope for loculated pleural effusions, however, has not been reported. In our patient, intrapleural urokinase instillation through the biopsy port of a semirigid thoracoscope at a dose of 60,000IU (diluted in 100mL of normal saline) induced fibrinolysis and dissolution of multiloculated pleural effusions in the vicinity of the thoracosope within only 10 minutes. It improved the field of view under medical thoracoscopy to the extent that we were able to perform parietal pleural biopsies and obtain the successful diagnosis of malignant pleural mesothelioma. We conclude that intrapleural instillation of urokinase may expand the diagnostic capability of medical thoracoscopy.

• Publication year

  2019

• Venue

  Journal of Bronchology & Interventional Pulmonology

• Publication date

  2019-04-01

• Fields of study

  Medicine, Engineering

• Identifiers
  DOI 10.1097/LBR.0000000000000555PMID 30908400
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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