Méthodes d'investigation de la plèvre

Abstract

Pleural diseases are frequently encountered in clinical practice. It is estimated that about 25% of the visits in a pulmonary service are due to a pleural disease. Their management involves various specialists such as pneumologists, radiologists, internal medicine specialists, cardiologists, paediatricians, oncologists, and thoracic surgeons. Located in a confined space, the pleural cavity, pleural diseases may originate from a broad spectrum of diseases, from local diseases of the lung and pleura to systemic conditions such as collagen vascular diseases or drug reactions. Despite modern investigation techniques, identifying the underlying cause is always a clinical challenge. Although the clinical presentations of pleural diseases are usually limited to pleuritic pain and dyspnea, various investigation procedures may be undertaken, always preceded by imaging to show potential effusion, thickening, or pneumothorax. Newer techniques as high resolution CT-scan or ultrasonography can be useful. Percutaneous pleural biopsy is no longer used for pleurisy (except in case of pleural tuberculosis) but thoracentesis using dedicated needle remains the first and best procedure to characterise the effusion (exsudate or transsudate). Currently, the procedure of choice for the management of pleural diseases is the thoracoscopy. By permitting complete exploration of the pleural cavity and many endopleural diagnostic or therapeutic procedures, this technique, significantly less invasive than a thoracotomy, is the cornerstone of the pleural cavity evaluation, constituting a real ‘window’ to the pleural space.