الفهرس 
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Abstract
The term medical thoracoscopy can be used to describe the diagnostic and therapeutic exploration of the pleural space carried out by the pulmonary physician, in the endoscopy unit, mostly under local anesthesia with or without conscious sedation. The urge for the resurgence of thoracoscopic techniques came essentially from the depressive situation of chronic exudates not diagnosed in 20-40% of cases after using the ordinary methods of thoracentesis, closed needle biopsy in addition to the routine biochemical, bacteriological, cytological and immunological assessments. The aim of this work was to study and evaluate the role of medical thoracoscopy in the diagnosis of undiagnosed pleural effusion. This study was done on 20 cases with exudative pleural effusion and the following was done : full history taken, clinical examination, full routine laboratory investigations, radiological examination in the form of chest x- ray and CT chest, abdominal US, tuberculin test, sputum for AFB 3 successive days, ABG, ECG, pleural aspiration and biochemical, cytological, bacteriological and immunological examination, blind Abrams pleural biopsy after negative aspiration and medical thoracoscopy if Abrams pleural biopsy was negative. Our results was that the mean age of patients was 57.6 ys and male to female ratio 1.2:1. Nine patients (45%) were either smokers or ex smoker & the result of biopsies taken were 65% malignancy 20% mesothelioma, 45% metastatic malignancies (15% bronchial adenocarcinoma, 10% cancer breast, 5% either lymphoma or thyomoma or heptocellular carcinoma or pancreatic carcinoma ), and 35% of cases were non-malignant (15% undiagnosed, 10% TB, 10% RA) and 20% of cases had complication in the form of 10% malposition of the intercostal tube and 5% of either haematoma or infection at the site of tube entry also In our results ADA was positive more than 40u/ml in 6 cases (30%), 2 of them diagnosed as TB while 3 cases diagnosed as mesothelioma and 1 case diagnosed as RA. Our results confirm that TB is diagnosed by ADA alone after exclusion of other cause which increase ADA. Also in our study 15% of cases (3 cases) diagnosed as non specific pleurities 66.7% of cases of them spontaneous resolution occurred with tube insertion and pleurodesis while one case 33.3% died later on during fellow up of unknown cause. Finally , thoracoscopy is safe and accurate diagnostic procedure which can be performed under local anesthesia with minimal complication .