Chest
Volume 117, Issue 5, May 2000, Pages 1404-1409
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Clinical Investigations
THE PLEURA
Successful Talc Slurry Pleurodesis in Patients With Nonmalignant Pleural Effusion

https://doi.org/10.1378/chest.117.5.1404Get rights and content

Background

Chemical pleurodesis is an effective treatment for malignant pleural effusion and pneumothorax. This mode of therapy is, however, less widely accepted in the treatment of patients with refractory benign or undiagnosed pleural effusion.

Study objectives

To analyze the outcome of talc slurry pleurodesis in patients with nonmalignant pleural effusions.

Design

Retrospective and partly prospective analysis of clinical outcome.

Setting

Hadassah University Hospital, Jerusalem, Israel.

Patients and participants

Between 1992 and 1997, we treated 16 patients with nonmalignant pleural effusion using talc slurry pleurodesis. The cause of effusion was congestive heart failure in 6 patients, liver cirrhosis in 4 patients, yellow nail syndrome in 1 patient, systemic lupus erythematosus in 1 patient, chylothorax in 1 patient, and undiagnosed in 3 patients.

Interventions

Nine patients were hospitalized, and seven patients received treatment in a day-care setting. Follow-up ranged from 2 months to 3 years.

Results

Complete success was observed in 12 cases (75%), partial success in 3 cases (19%), and pleurodesis was ineffectual in 1 case (6%). There were no significant complications after the procedure in any of our patients. A review of the English-language medical literature revealed an additional 110 reported cases of nonmalignant pleural effusion that were treated with chemical pleurodesis. Of these cases, talc was used in 65% with a success rate of nearly 100%.

Conclusions

Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. This procedure is safe and easily performed and, in selected cases, can be performed in an outpatient day-care setting.

Section snippets

Patients

From 1992 to 1997, we treated 16 patients with chemical pleurodesis (Table 1). Patients referred to the pulmonary clinic or seen as inpatients at Hadassah University Hospital, Jerusalem, Israel, were considered candidates for chemical pleurodesis if they had a large (usually one third of the pleural cavity) symptomatic effusion that required therapeutic thoracocentesis at least once a month.

Pleurodesis Technique

A chest drain was inserted in all cases. On nine occasions, the patient was hospitalized for 2 to 5 days,

Results

There were eight men and eight women, ages 21 to 87 years (median, 66 years) (Table 1). The diagnosis for which pleurodesis was performed included CHF in 6 patients, liver cirrhosis in 4, systemic lupus erythematosus (SLE) in 1, yellow nail syndrome (YNS) in 1, chylothorax in 1, and in 3 patients, the cause of effusion was unknown. In five instances, the effusion was exudative, and in 11, it was transudative. All patients had multiple pleural taps (2 to 50; mean, 6) before pleurodesis. In 13

Discussion

The present study demonstrates that the intrapleural administration of 2 to 3 g of talc in a slurry was an effective treatment for nonmalignant recurrent pleural effusion. In previous studies, talc slurry has been very effective in treating malignant pleural effusion and pneumothorax. There are > 600 reported cases of talc used in the treatment of pneumothorax and > 650 in primary or secondary malignant pleural effusion.2, 34, 89, 10 Talc has been used less frequently for the treatment of

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