ROLE OF MEDICAL THORACOSCOPY IN TREATMENT OF PARAPNEUMONIC EFFUSIONS Dr. Mohamed Mostafa Kamel MBBCh,MSc, MD Professor of Pulmonology Kasr El Aini Faculty of Medicine Cairo University Identification: pleural fluid aspiration All patients with a pleural effusion in association with sepsis or a pneumonic illness require diagnostic pleural fluid sampling. (C) If a pleural effusion is identified on the chest x-ray of a patient with possible pleural infection, it is impossible clinically to differentiate the presence of a complicated parapneumonic effusion requiring chest tube drainage from a simple effusion that may resolve with antibiotics alone. Imaging guidance should be used since this minimises risks of organ perforation and improves the recovery rate of pleural fluid. Sampling using thoracic ultrasound is simple, safer and will reduce patient discomfort. Sampling can be performed by sterile procedure using a needle and syringe with local anaesthetic if necessary. Small effusions (ie,