Pleurovideoscopy in a general hospital

A 48 a year old Malay gentleman, was investigated for recurrent unexplained right pleural effusion. Initial investigations showed exudative pleural effusion with neutrophil predominance. Tuberculosis (TB) workout were negative. Pleuroscopy showed multiple adhesions with granulomatous deposits at the parietal pleural surface. Adhesions were released by forceps. A chest tube was inserted. Intrapleural streptokinase instilled for three consecutive days. TB treatment was initiated. There was clinical and radiological improvement and he was discharged well after one week of hospitalization. He remained well at follow-up two months later.