8 Contraindications
Medical thoracoscopy/pleuroscopy (MT/P) is a safe procedure with only a few absolute and relative contraindications (Table 8.1), and these follow logically, for the most part, from the preceding chapter describing the clinical prerequisites for the procedure.
An absolute contraindication is lack of pleural space resulting from extensive adhesions of the pleural layers (e.g., in pleural fibrosis, after infections, or previous pleurodesis) since it is impossible to carry out the procedure if the pleural space has been obliterated (often this can be suspected from the patient’s history or from ultrasound or radiography (Fig. 8.1). A partial pneumothorax of at least 100-200 mL, or of approximately 2-4 cm in depth, must be present or induced. Otherwise, the thoracoscope/pleuroscope cannot be inserted safely without danger of injuring the lung or other organs. Sometimes this technical difficulty may be overcome by enlarging the skin incision and digitally dissecting the lung away from the chest wall, a technique originally described as so-called “extended thoracoscopy” (Janssen and Boutin 1992). For details see “Access to the Pleural Space,” Chapter 11, p. 78 ff.
Coagulopathies usually provide only relative contraindications. More severe coagulopathies are a contraindication at least to biopsy procedures that do not allow immediate local control. The platelet count should be in excess of 60000, and the International Normalized Ratio (INR) less than 1.2 (Rodriguez-Panadero et al. 2006), otherwise a correction of the coagulopathy must be undertaken prior to the procedure. There are no MT/P studies on the risk of bleeding in patients with aspirin or clopidogrel medication. A report on the risk after transbronchial biopsies did not reveal increased bleeding with aspirin (Herth et al. 2002). The risk of bleeding is also higher in patients with renal insufficiency and elevated nitrogen urea (> 30 mg/ dL) or creatinine (> 3 mg/dL).
Table 8.1 Absolute and relative contraindications to medical thoracoscopy/pleuroscopy
Absolute | Relative |
|---|---|
Lack of pleural space due to: • Advanced empyema • Pleural thickening of unknown etiology • Suspected mesothelioma where the visceral and partial surfaces are fused  Stay updated, free articles. Join our Telegram channel
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