ABSTRACT
The estimated annual incidence of malignant pleural effusions in the United States
is 150,000 cases. Patients most commonly present with dyspnea, initially on exertion
and later at rest. Chemical pleurodesis is the most common modality of therapy for
patients with recurrent, symptomatic, malignant pleural effusion. Talc is the most
successful pleurodesis agent, and talc poudrage and slurry have equal efficacy. Although
a number of cases of acute respiratory failure have been associated with talc pleurodesis,
the incidence is < 1% and many of these episodes cannot be clearly attributed to talc
alone. Although a low pleural fluid pH is associated with a decreased survival and
less successful pleurodesis, pH should not be the sole criterion for recommending
or withholding pleurodesis. Other factors that need to be considered before recommending
pleurodesis include relief of dyspnea after therapeutic thoracentesis, general health
of the patient, performance status, presence of trapped lung, and the primary malignancy.
Pleuroperitoneal shunt or chronic indwelling catheter should be considered for patients
who fail pleurodesis or who have a trapped lung.
KEYWORD
Malignant pleural effusions - treatment - talc pleurodesis - trapped lung - pleural
fluid pH - acute respiratory failure
