Download PDF
Semin Respir Crit Care Med 2010; 31(6): 734-742
DOI: 10.1055/s-0030-1269833
© Thieme Medical Publishers

Management of Pleural Effusion in the Cancer Patient

Peter Doelken1
  • 1Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina
Further Information

Publication History

Publication Date:
06 January 2011 (online)

    Permissions and Reprints

ABSTRACT

The differential diagnosis of a pleural effusion is expanded in the cancer patient. A cancer patient may have a malignant pleural effusion, a pleural effusion indirectly caused by the cancer or its treatment, or a pleural effusion unrelated to the cancer. The approach to the cancer patient with a pleural effusion must take into account the impact of the pleural effusion on quality of life, type and stage of the underlying cancer, impact of biopsy procedures on cancer staging, availability of treatment of the underlying cancer, performance status, and patient preferences. Minimally invasive palliative treatment options for the management of symptomatic malignant pleural effusion, such as chronic indwelling pleural catheters, have not only changed the treatment of the effusion but also require a reassessment of what constitutes an adequate diagnostic evaluation prior to considering such treatment options. Of particular concern to the clinician is the cytologically negative exudative pleural effusion for which a cause could not be established after the initial diagnostic evaluation. The decision to proceed to more invasive diagnostic testing must be individualized and the clinician must consider the limitations of histopathological examination of tissue obtained by invasive procedures.

KEYWORDS

Paramalignant pleural effusion - malignant pleural effusion - pleural fluid analysis - pleural biopsy - thoracoscopy

REFERENCES

  • 1 Sahn S A. The diagnostic value of pleural fluid analysis.  Semin Respir Crit Care Med. 1995;  16 269-278
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 van den Toorn L M, Schaap E, Surmont V F, Pouw E M, van der Rijt K C, van Klaveren R J. Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter.  Lung Cancer. 2005;  50 123-127
    CrossrefPubMedGoogle Scholar
  • 3 Putnam Jr J B, Walsh G L, Swisher S G et al.. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter.  Ann Thorac Surg. 2000;  69 369-375
    PubMedGoogle Scholar
  • 4 Pollak J S, Burdge C M, Rosenblatt M, Houston J P, Hwu W J, Murren J. Treatment of malignant pleural effusions with tunneled long-term drainage catheters.  J Vasc Interv Radiol. 2001;  12 201-208
    CrossrefPubMedGoogle Scholar
  • 5 Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion.  Chest. 2006;  129 362-368
    CrossrefPubMedGoogle Scholar
  • 6 Pien G W, Gant M J, Washam C L, Sterman D H. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion.  Chest. 2001;  119 1641-1646
    CrossrefPubMedGoogle Scholar
  • 7 Musani A I, Haas A R, Seijo L, Wilby M, Sterman D H. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters.  Respiration. 2004;  71 559-566
    CrossrefPubMedGoogle Scholar
  • 8 Saffran L, Ost D E, Fein A M, Schiff M J. Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter.  Chest. 2000;  118 417-421
    CrossrefPubMedGoogle Scholar
  • 9 Sartori S, Tombesi P, Tassinari D et al.. Sonographically guided small-bore chest tubes and sonographic monitoring for rapid sclerotherapy of recurrent malignant pleural effusions.  J Ultrasound Med. 2004;  23 1171-1176
    PubMedGoogle Scholar
  • 10 Caglayan B, Torun E, Turan D et al.. Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large-bore chest tube.  Ann Surg Oncol. 2008;  15 2594-2599
    CrossrefPubMedGoogle Scholar
  • 11 Heffner J E. Management of the patient with a malignant pleural effusion.  Semin Respir Crit Care Med. 2010;  In press
    Google Scholar
  • 12 Mayo P H, Doelken P. Pleural ultrasonography.  Clin Chest Med. 2006;  27 215-227
    CrossrefPubMedGoogle Scholar
  • 13 Barnes T W, Morgenthaler T I, Olson E J, Hesley G K, Decker P A, Ryu J H. Sonographically guided thoracentesis and rate of pneumothorax.  J Clin Ultrasound. 2005;  33 442-446
    CrossrefPubMedGoogle Scholar
  • 14 Swiderek J, Morcos S, Donthireddy V et al.. Prospective study to determine the volume of pleural fluid required to diagnose malignancy.  Chest. 2010;  137 68-73
    CrossrefPubMedGoogle Scholar
  • 15 Feller-Kopman D, Walkey A, Berkowitz D, Ernst A. The relationship of pleural pressure to symptom development during therapeutic thoracentesis.  Chest. 2006;  129 1556-1560
    CrossrefPubMedGoogle Scholar
  • 16 Feller-Kopman D. Therapeutic thoracentesis: the role of ultrasound and pleural manometry.  Curr Opin Pulm Med. 2007;  13 312-318
    CrossrefPubMedGoogle Scholar
  • 17 Huggins J T, Doelken P. Pleural manometry.  Clin Chest Med. 2006;  27 229-240
    CrossrefPubMedGoogle Scholar
  • 18 Benamore R E, Scott K, Richards C J, Entwisle J J. Image-guided pleural biopsy: diagnostic yield and complications.  Clin Radiol. 2006;  61 700-705
    CrossrefPubMedGoogle Scholar
  • 19 Agarwal P P, Seely J M, Matzinger F R et al.. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy.  Radiology. 2006;  241 589-594
    CrossrefPubMedGoogle Scholar
  • 20 Diacon A H, Schuurmans M M, Theron J, Schubert P T, Wright C A, Bolliger C T. Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists.  Respiration. 2004;  71 519-522
    CrossrefPubMedGoogle Scholar
  • 21 Noppen M. The utility of thoracoscopy in the diagnosis and management of pleural disease.  Semin Respir Crit Care Med. 2010;  In press
    PubMedGoogle Scholar
  • 22 Agrawal V, Doelken P, Sahn S A. Pleural fluid analysis in chylous pleural effusion.  Chest. 2008;  133 1436-1441
    CrossrefPubMedGoogle Scholar
  • 23 Huggins J T, Sahn S A, Heidecker J, Ravenel J G, Doelken P. Characteristics of trapped lung: pleural fluid analysis, manometry, and air-contrast chest CT.  Chest. 2007;  131 206-213
    CrossrefPubMedGoogle Scholar
  • 24 Abu-Shakra M, Nicol P, Urowitz M B. Accelerated nodulosis, pleural effusion, and pericardial tamponade during methotrexate therapy.  J Rheumatol. 1994;  21 934-937
    PubMedGoogle Scholar
  • 25 Everts C S, Westcott J L, Bragg D G. Methotrexate therapy and pulmonary disease.  Radiology. 1973;  107 539-543
    PubMedGoogle Scholar
  • 26 Walden P A, Mitchell-Weggs P F, Coppin C, Dent J, Bagshawe K D. Pleurisy and methotrexate treatment.  BMJ. 1977;  2 867
    CrossrefPubMedGoogle Scholar
  • 27 Jones S E, Moore M, Blank N, Castellino R A. Hypersensitivity to procarbazine (Matulane) manifested by fever and pleuropulmonary reaction.  Cancer. 1972;  29 498-500
    CrossrefPubMedGoogle Scholar
  • 28 Farney R J, Morris A H, Armstrong J D, Hammer S. Diffuse pulmonary disease after therapy with nitrogen mustard, vincristine, procarbazine, and prednisone.  Am Rev Respir Dis. 1977;  115 135-145
    PubMedGoogle Scholar
  • 29 Ecker M D, Jay B, Keohane M F. Procarbazine lung.  AJR Am J Roentgenol. 1978;  131 527-528
    PubMedGoogle Scholar
  • 30 Schaap N, Raymakers R, Schattenberg A, Ottevanger J P, de Witte T. Massive pleural effusion attributed to high-dose cyclophosphamide during conditioning for BMT.  Bone Marrow Transplant. 1996;  18 247-248
    PubMedGoogle Scholar
  • 31 Orwoll E S, Kiessling P J, Patterson J R. Interstitial pneumonia from mitomycin.  Ann Intern Med. 1978;  89 352-355
    PubMedGoogle Scholar
  • 32 Gunstream S R, Seidenfeld J J, Sobonya R E, McMahon L J. Mitomycin-associated lung disease.  Cancer Treat Rep. 1983;  67 301-304
    PubMedGoogle Scholar
  • 33 Ozols R F, Hogan W M, Ostchega Y, Young R C. MVP (mitomycin, vinblastine, and progesterone): a second-line regimen in ovarian cancer with a high incidence of pulmonary toxicity.  Cancer Treat Rep. 1983;  67 721-722
    PubMedGoogle Scholar
  • 34 Wohlrab J L, Liu M C, Anderson E D, Kia Noury D B, Read C A, Warren R D. Docetaxel induced pleural effusions.  [abstract] Chest. 2002;  122 S94-S95
    PubMedGoogle Scholar
  • 35 Goldblatt M, Huggins J T, Doelken P, Gurung P, Sahn S A. Dasatinib-induced pleural effusions: a lymphatic network disorder?.  Am J Med Sci. 2009;  338 414-417
    CrossrefPubMedGoogle Scholar

Peter DoelkenM.D. 

Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina

96 Jonathan Lucas St., Rm. 812 CSB, Charleston, SC 29425

Email: doelkenp@musc.edu

      >