When to image post-thoracoscopy?

Introduction Chest radiography day 1 post-thoracoscopy to review lung re-expansion is suggested by the British Thoracic Society 1 . Practice in the UK has been compared to areas where medical thoracoscopy is a day case procedure. Objectives To review the length of stay, time to lung re-inflation and survival interval following thoracoscopy in a district general hospital. Methods A retrospective study identified patients undergoing medical thoracoscopy between 01/06/2007 and 31/12/2011. Casenotes and electronic records were reviewed to obtain tissue diagnosis, imaging intervals and length of stay post-procedure. Images were reviewed to determine rates of lung re-inflation and fluid re-accumulation. Results 123 patients were identified. Pleural biopsies were taken at 95% of procedures, with a diagnostic sensitivity of 97%. 47% of cases were positive for malignant mesothelioma. Time to initial chest radiography ranged from 0-4 days. First imaging at day 1 had 63% re-inflation compared to 78% at day 2 post-thoracoscopy. Persistent effusion was noted in 56 cases, pneumothorax in 11 and both were present in 21. Length of stay averaged 4.4 days, with 45% patients discharged within 2 days. Conclusion Overall 30% of patients had not achieved lung re-inflation at first imaging, up to 2 days post-thoracoscopy. Initial imaging on day 2 provides time for re-inflation whilst avoiding repeated chest radiographs. 1 Local Anaesthetic Thoracoscopy, BTS Pleural Disease Guideline, 2010.