Ultrasound for medical thoracoscopy

The method for thoracoscopy described since Jacobaeus performed his first routine medical thoracoscopies depends upon being able to access the pleural space, which if absent relies upon the induction of a pneumothorax (Marchetti et al. 2011). Inducing a pneumothorax was frequently performed immediately prior to the procedure or more classically on the preceding day. This was followed by a chest radiograph to confirm the presence of a free pleural cavity thus allowing safe access and subsequent optimal inspection. Although induction of a pneumothorax is a safe procedure, it does require further intervention of the pleural space and therefore, theoretically at least, increase the risk of complications – especially iatrogenic pleural infection. Further, it requires the patient to be admitted for an additional day at an associated increase in cost.