Medical Thoracoscopy in Pleural Effusion Versus Dry Space: A Comprehensive Literature Review on Diagnostic Yield and Complication Rates

Background: Medical thoracoscopy (MT) represents the gold standard for undiagnosed pleural effusions, traditionally performed in the presence of pleural fluid. Recent technical advances have enabled MT in "dry space" conditions (minimal or absent pleural effusion), raising questions about comparative diagnostic efficacy and safety profiles. Objective: This literature review aims to evaluate diagnostic yield and complication rates between traditional MT performed in patients with current pleural effusion and dry medical thoracoscopy (DMT). Results: MT demonstrates diagnostic sensitivity ranged from 80% to 96.3% and specificity close to 100% for malignant pleural disease and diagnostic accuracy is 99.1% for tuberculous pleuritis. DMT using ultrasound guidance achieves comparable diagnostic yield, with recent studies reporting optimal success rates in pleural access and tissue sampling, and diagnostic sensitivity for malignancy up to 100%. Major complication rates are comparable between MT and DMT, with no significant differences in overall adverse events. Mortality rates remain exceptionally low (≤0.1%) for both approaches. Conclusions: MT remains a highly effective diagnostic tool for pleural diseases. DMT represents a valid and safe alternative in patients without significant pleural effusion, offering comparable diagnostic yield. Although technically more demanding, DMT expands diagnostic possibilities in selected clinical scenarios.