Intrapleural Urokinase Directly Under Medical Thoracoscopy for the Diagnosis of Malignant Pleural Mesothelioma With Severe Multiloculated Pleural Effusions

Our plain-English summary of Intrapleural Urokinase Directly Under Medical Thoracoscopy for the Diagnosis of Malignant Pleural Mesothelioma With Severe Multiloculated Pleural Effusions, by S. Terashita, H. Kawachi, S. Horikawa, et al (Journal of Bronchology & Interventional Pulmonology, 2019).

The study

• Authors: S. Terashita, H. Kawachi, S. Horikawa, S. Noguchi, T. Ikeue, T. Sugita
• Journal: Journal of Bronchology & Interventional Pulmonology
• Published: 2019;26(2):e26-e27
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor describing a single patient treated at the Japanese Red Cross Wakayama Medical Center in Japan. A 50-year-old man with no significant past medical history had two weeks of shortness of breath and fluid around the right lung (a pleural effusion). A first fluid sample did not give a diagnosis, so the doctors performed medical thoracoscopy, looking inside the chest through a scope. Heavy fibrin deposits split the fluid into many pockets and blocked the view. Breaking them up with biopsy forceps did not help. The doctors then put 60,000 IU of urokinase, a clot-dissolving drug, in 100 mL of saline directly through the scope. Within about 10 minutes the fibrin walls near the scope had dissolved, though only in a limited space. This showed diffusely thickened lining of the chest wall, which they biopsied. The procedure took 78 minutes with no complications. Tissue tests led to a diagnosis of epithelioid pleural mesothelioma. The letter does not mention asbestos. The authors concluded that urokinase given this way may expand the diagnostic capability of medical thoracoscopy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (letter to the editor describing one patient)
• Who was studied: One 50-year-old man with no significant past medical history and a right-sided pleural effusion, seen at the Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
• Exposure: Not reported; the letter does not mention asbestos or any other exposure. The intervention studied was 60,000 IU of urokinase in 100 mL of 0.9% saline, instilled through the thoracoscope during the procedure.
• Main results:
  • In this patient, urokinase dissolved the fibrin pockets near the thoracoscope within about 10 minutes.
  • Once the view cleared, the doctors could see the parietal pleura (the lining of the chest wall), which was diffusely thickened, and they biopsied it.
  • The thoracoscopy was completed without any complications.
  • The examination took 78 minutes.
  • The biopsy stained positive for calretinin, WT1 and D2-40 and negative for CEA and TTF-1, and the patient was diagnosed with epithelioid pleural mesothelioma.
  • The diagnosis was epithelioid pleural mesothelioma.
  • The next day, the chest X-ray showed a well-expanded right lung.
• The authors' conclusion: The authors concluded that putting urokinase into the pleural space may expand the diagnostic capability of medical thoracoscopy.
• Limitations the authors state:
  • The view was cleared only within a limited space near the thoracoscope, though the authors state this was enough to take biopsies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Medical Thoracoscopy, Pleural Mesothelioma, Pleural Effusion.

Related studies

• Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial — M. Metintas, G. Ak, et al. (2010)
• Medical thoracoscopy in the diagnosis of unexplained pleural effusion — M.L. Wilsher, A.G. Veale (1998)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Expression and activity of urokinase and its receptor in endothelial and pulmonary epithelial cells exposed to asbestos — A. Barchowsky, R.R. Roussel, et al. (1998)
• Three types of human lung tumour cell lines can be distinguished according to surface expression of endogenous urokinase and their capacity to bind exogenous urokinase — R. Schwartz-Albiez, H.H. Heidtmann, et al. (1992)
• Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy — M. Metintas, G. Ak, et al. (2012)

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