Medical Thoracoscopy in Hyderabad: Finding the Cause of Fluid Around the Lung

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Being told there’s “fluid around your lung” usually comes with a second, harder sentence: we don’t yet know why. In India, the most common causes of an unexplained effusion are tuberculosis and cancer, and they’re treated completely differently. Thoracoscopy is often the step that settles which one it is.

The lungs sit inside a thin lining called the pleura. Normally there’s only a few teaspoons of fluid between its two layers. A pleural effusion is when that space fills with fluid, sometimes litres of it, squeezing the lung and causing breathlessness.

In medical thoracoscopy, the doctor makes one small cut between the ribs on the affected side, drains the fluid, and passes a thin camera (a thoracoscope) into the space. They can see the lining directly, spot nodules, thickening or inflammation, and take biopsies from exactly the areas that look abnormal. At the end, a chest drain is placed through the same cut.

It’s called “medical” thoracoscopy because it’s done by a pulmonologist, usually under local anaesthetic and sedation, rather than by a surgeon under general anaesthetic.

Thoracoscopy is rarely the first test. The usual order is:

• Imaging: a chest X-ray and chest ultrasound confirm the fluid and show how much there is. A CT scan of the chest often follows.
• Pleural tap (thoracentesis): a needle removes some fluid, guided by ultrasound. The fluid is tested for protein, LDH, cell counts, ADA (a TB marker), cancer cells and infection. This settles many cases.
• Thoracoscopy: when the tap is inconclusive, or the fluid keeps coming back, a pleural biopsy under direct vision is the next step.

TB is one of the commonest causes of pleural effusion in India. A high ADA level in the fluid supports it, but the fluid itself rarely grows TB bacteria. A thoracoscopic biopsy can show the typical TB changes (granulomas) and allow tissue to be tested for TB, including drug resistance, before months of treatment begin.

Lung cancer, breast cancer, lymphoma and mesothelioma can all spread to the pleura. Fluid tests find cancer cells in only some of these cases. Thoracoscopy lets the doctor biopsy the visible nodules, which gives enough tissue for the cancer type and, where relevant, the molecular tests that guide modern treatment. If the cause is cancer, the fluid can be controlled in the same session (see pleurodesis below).

Thoracoscopy is considered when:

• An effusion is still unexplained: the fluid is an exudate (the type caused by inflammation, infection or cancer), and tap results haven’t given an answer
• TB is suspected but unproven: for example, a high ADA with no other confirmation, or when drug-resistance testing matters
• Cancer is suspected: CT shows pleural thickening or nodules, or there’s a history of asbestos exposure
• Fluid keeps returning: in a known cancer, to drain it and prevent re-accumulation (pleurodesis or a catheter)

It may not be suitable if the lung is stuck to the chest wall with no space to work in, if there’s a bleeding problem that can’t be corrected, or if you can’t lie on your side for the procedure.

When fluid is likely to keep returning, usually because of cancer, two options can be offered during or after thoracoscopy:

• Talc pleurodesis: sterile medical talc is sprayed over the lining. It causes the two layers to stick together, leaving no space for fluid to collect. This can be done during the thoracoscopy itself (called “poudrage”).
• Indwelling pleural catheter (IPC): a soft tube is tunnelled under the skin, so fluid can be drained at home as often as needed. Useful when the lung can’t fully re-expand.

Which one suits you depends on how well the lung re-expands, how quickly the fluid returns and what matters most to you. It’s discussed before the procedure.

• Tests beforehand: a chest ultrasound and usually a CT scan, blood count and clotting tests.
• Blood thinners: aspirin, clopidogrel, warfarin and newer blood thinners usually need to be stopped for a set number of days. Your doctor will tell you exactly when. Never stop them on your own.
• Fasting: about 6 hours before the procedure.
• Medicines: take your usual blood pressure and other medicines with a sip of water unless told otherwise. Tell the team if you’re diabetic.

• You lie on your healthy side. An ultrasound confirms the best spot to enter.
• You’re given sedation and pain relief through a drip, and the skin and chest wall are numbed with local anaesthetic. You stay breathing on your own throughout.
• A small cut (about 1–2 cm) is made between the ribs and a port is inserted. The fluid is drained.
• The thoracoscope is passed in. The doctor examines the whole lining and takes several biopsies from abnormal areas.
• If planned, talc is sprayed (pleurodesis) or a catheter is placed.
• A chest drain is inserted through the same cut and the skin is stitched around it.

The procedure takes about 30–60 minutes. A chest X-ray is done afterwards.

• Chest drain: it stays in until the fluid stops and the lung has re-expanded. In one recent Indian study, drains stayed about 3 days on average for TB and about a week for cancer.
• Pain: some chest discomfort around the drain is expected and is managed with regular painkillers. In a 2024 Indian study, almost every patient had some chest pain, mostly mild.
• Going home: usually once the drain is out . The stitch is removed in about 7–10 days.
• Back to normal: most people return to light activity within a week.

Seek help urgently if you have:

• Increasing breathlessness
• Fever, or redness or discharge from the wound
• Swelling under the skin of the chest or neck that is spreading

Medical thoracoscopy is regarded as a safe procedure. A 2022 review pooling the published studies found complications in about 4% of procedures and a death rate below 0.5%, mostly linked to an older, non-graded type of talc that is no longer recommended.

Indian studies report similar safety:

• AIIMS Raipur and SCB Cuttack, 2024 (105 patients): no deaths or major complications. Minor bleeding in 16% needed no specific treatment, and almost all patients had some chest pain, mostly mild.
• UPUMS Saifai, 2026 (103 patients): complications in about 11%, mostly minor: bleeding (4%), air under the skin (2%) and slow wound healing (2%, both in diabetics). One death was attributed to advanced lymphoma rather than the procedure.

Other possible risks include infection, a persistent air leak, and reactions to sedation. Your own risk depends on your general health and is discussed before you consent.

Thoracoscopy gives a diagnosis in the large majority of people who need it:

• AIIMS Raipur and SCB Cuttack, 2024: a diagnosis in about 90% of 105 patients with previously undiagnosed exudative effusions. Cancer was found in 46% and TB in 32%.
• UPUMS Saifai, 2026: a diagnosis in about 95% of 103 patients. Cancer was found in 36%, TB in 28% and inflammatory pleuritis in 30%.

Sometimes the biopsy shows only “non-specific inflammation”. That isn’t always the final answer, and you may be followed up with repeat scans, because a small number of these later turn out to be TB or cancer.

Biopsy results usually take days . TB cultures can take up to 6–8 weeks, though rapid molecular TB tests are faster. You’ll have a follow-up consultation to go through the results and the treatment plan, which may be TB treatment, cancer care with the oncology team, or monitoring.

What changes the cost:

• Length of stay: mostly decided by how long the chest drain is needed
• Room category
• Extras: pleurodesis, a catheter, or TB molecular tests

Insurance: thoracoscopy is an in-patient procedure and is generally covered under health insurance policies, subject to terms. Apollo’s insurance desk confirms cashless approval beforehand.

Medical thoracoscopy is performed by Dr. Kishan Srikanth Juvva .

• Training:
• DM in Pulmonary and Critical Care Medicine
• Master’s in Interventional Pulmonology from the University of Florence, Italy, a programme focused on bronchoscopic and pleural procedures
• Memberships:
• World Association for Bronchology and Interventional Pulmonology
• European Respiratory Society
• Indian Association for Bronchology

about Dr. Kishan

If you’ve been told you have fluid around the lung, bring your chest X-ray, ultrasound or CT report and any fluid test results to the first visit.