Occurrence of mitral valve prolapse in nonsmoker spontaneous pneumothorax patients.

pleuroscopy “over conventional means of diagnosis is unclear” is virtually impossible to draw from the paper of Faurschou et al. Pleuroscopy deserves, indeed, more attention. Since 1910,2 pleuroscopy has been widely used, mainly in Europe, as a diagnostic and therapeutic procedure. Its diagnostic yield in pleural effusion is close to 100 percent. Pleuroscopy is usually performed with the use ofiocal anesthesia and, although it requires hospitalization, has several advantages over closed pleural biopsy: (1) It allows examination ofthe pleural cavity, including the costal pleura, the diaphragmatic dome, the cardiophrenic and costophrenic angles, the lung surface and fissural aspects of the lobes, and the mediastinal pleura. (2) Pleural biopsies can be taken at multiple sites under visual control. (3) Lung biopsies can be taken easiiy.78 (4) Instillation of sclerosing agents for chemical pleurodesis” can be done at the end of the procedure if a frozensection biopsy yields a positive result for malignancy. Complications of pleuroscopy, such as subcutaneous emphysema, shortness of breath, and arrhythmias, are observed in less than 10 percent of the patients.’#{176} Mortality is minimal: only one death was found in a review ofapproximately 8,000 diagnostic pleuroscopic procedures. ‘#{176} We believe that, ifthe same diseases can cause both symptomatic and asymptomatic pleural eff#{252}sions (as Smyrnios et al concluded), amore active diagnostic workup should be established, especially to rule out malignancy and tuberculosis. Therefore, pleuroscopywhich is clearly superior to repeated pleural fluid cytology and blind pleural biopsy’s-should be considered when a thoracentesis with closed pleural biopsy has not been diagnostic and the probable cause of the effusion is not clinically apparent.