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Risk of thoracoscopy in a CAD patient

Q: I am an 84 years old non-diabetic male. I have been on drugs for CAD and hypertension. I quit smoking 35 years ago. My symptoms are as follows- Pleural effusion right lung since 23 May 2002, severe cough and weakness. Tests carried out so far-Pleural fluid cytology carried out 6 times - No malignant cells seen; only lymphocytes, mesothelial cells and RBCs seen. Pleural biopsy (fine needle) - No malignancy detected. Pleural fluid biochemistry - No abnormality detected. Liver function tests - normal. CT Scan Chest - Right pleural effusion and fluffy parenchyma in right lungs (probably infective pathology). No other significant findings. CT Scan Abdomen - normal. Treatment: Anti-tubercular treatment from 23 May 2002. However, pleural effusion continues without relief. Pleural aspiration has been done 4 times between 23 May and 10 July 2002 and each time about 1.3 liters of fluid was removed. Suggested tests: Video bronchoscopy. It was considered risky in view of advanced age and cardiac condition and hence, was not done. Thoracoscopy & Biopsy: Planned shortly. However, risk of same not known. Please let me know the illness and whether I can undergo thoracoscopy.

A:It would seem that the logical next step in order to find a diagnosis is a thoracoscopy with pleural biopsy. Most such procedures have some associated risk. The exact risk in a given patient, depends upon associated medical conditions, amongst other factors. Your treating chest physician is the best person to assess this risk.

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