Situation
The chest physicians refer you a patient for a VAT pleural biopsy. They fail
to mention that they have previously done a tetracycline pleurodesis. What would
you do ?
Assuming there is minimal pleural effusion, as if there is an effusion the pleurodesis has not worked so you can do a VAT as usual.
Options:
1.
The first question is was the pleurodesis on the same side as the biopsy is needed. If yes, then
CT biopsy is the way forward, but you may have to wait until a mass appears that
is big enough to biopsy. The risk of pneumothorax is low as the lung is stuck.
2. An open biopsy is an option if what you want to biopsy is not very
posterior and not a long way from the proposed surgical incision