Another advantage of pleuroscopy is the ability to take biopsy from the visceral pleura under direct visualisation. This patient has pleural effusion in the right lung. During pleuroscopy, the 3 lobes can be seen. The parietal pleura is macroscopically normal. The upper and middle lobes are also normal. However, upon closer examination, one can see 'caseating lesion' on the visceral surface of the lower lobe. A flexible forceps is used to biopsy the lesion. Closed blind pleural biopsy via an Abrams needle will definitely miss the lesion on the visceral surface.
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