Exploratory thoracotomy with pleural biopsy was performed in 17 patients who had idiopathic pleural effusions. In each case the operation was done because the usual procedures of thoracentesis, sputum examination, bronchoscopy, and scalene lymph node biopsy had failed to settle the diagnosis. The thoracic cavity was entered by an incision not exceeding 20 cm. in length through the sixth, seventh, or eighth interspace, which permitted exploration of the corresponding half of the thoracic cavity and removal of biopsy specimens. The diagnoses were postpneumonic effusion in seven cases, carcinoma in six, sarcoma in one, tuberculosis in two, and lymphoma in one. Two cases are described in detail to illustrate chronic tuberculous pleurisy in one patient and lymphoblastoma in the other. This method of "small thoracotomy" is suggested for cases in which idiopathic effusions remain unexplained after careful medical and laboratory examinations.
Lansden FT, Falor WH. "DIAGNOSTIC SMALL THORACOTOMY" IN IDIOPATHIC PLEURAL EFFUSION. JAMA. 1959;170(12):1375–1379. doi:10.1001/jama.1959.03010120011004
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