PP18 EXPANDING ACCESS TO PLEURAL DISEASE DIAGNOSIS: PLEUROSCOPY OUTCOMES FROM A DISTRICT HOSPITAL IN MALAYSIA

Farina Kamal Hizat, Muhammad Khairul Taufiq Rosli.

Hospital Tawau, Tawau, Malaysia

Introduction
Diagnosing exudative pleural effusions is challenging in TB-endemic areas with limited diagnostics. Before pleuroscopy, fewer pleural TB and lung malignancy cases were detected, causing diagnostic delays. Pleuroscopy provides a minimally invasive way to obtain pleural biopsies for earlier diagnosis and management.

Objectives
To evaluate the diagnostic yield, safety, and clinical impact of pleuroscopy for undiagnosed exudative pleural effusions at a district hospital.

Methodology
A retrospective review of pleuroscopies from August 2024 to May 2025 at Hospital Tawau was conducted. Procedures were done by trained general physicians, showing feasibility and safety outside tertiary centers. Patients with persistent, undiagnosed exudative pleural effusions after thoracentesis were included. Data on diagnoses, complications, treatments, and outcomes were analyzed.

Results
Fifty pleuroscopies were performed. Tuberculosis was diagnosed in 12 patients, advanced lung malignancy in 10, and bacterial infections in others; no fungal infections found. These represent a significant increase from the pre-pleuroscopy period, reflecting improved diagnostics. Pleuroscopy allowed direct visualization of pleural septations, guiding intrapleural streptokinase to improve drainage and reduce fibrosis. Early anti-TB treatment was started based on findings, reducing delays. No major complications occurred; all patients were discharged.

Conclusions
Pleuroscopy, safely performed by trained general physicians, is an effective diagnostic and therapeutic tool for undiagnosed exudative pleural effusions in resource-limited district hospitals. It expands access, improves diagnosis and treatment speed, and guides interventions like intrapleural fibrinolysis, enhancing outcomes. Expanding pleuroscopy and training at district hospitals could strengthen TB and pleural disease management in endemic areas.