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Pleurodesis
Gerald F. Abbott, MD, FACR; Florian J. Fintelmann, MD, FRCPC
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Pleural sclerosis
              • Talc poudrage
            • Definitions

              • Chemical pleural sclerosis to treat refractory malignant pleural effusion and spontaneous pneumothorax
              • Other indications
                • Recurrent benign pleural effusions: Heart failure, ascites, systemic lupus erythematosus
                • Recurrent pneumothorax: COPD, lymphangioleiomyomatosis, catamenial
                • Chylothorax: Postsurgical, post-traumatic
              • Contraindications
                • Infection, advanced heart disease, coagulation disorders
              • Pleurodesis agents and methods
                • Pure talc (hydrated magnesium silicate)
                  • Most used/most effective sclerosant agent
                  • Highest success rate for malignant pleural effusion
                  • 4-8% risk of respiratory failure after talc exposure
                  • Side effects may be related to smaller particle size
                • Bleomycin
                  • Readily available
                  • More expensive; must be used immediately
                • Tetracycline and derivatives
                  • Doxycycline, minocycline
                  • Inexpensive, can be stored
                • Chemotherapy agents: Cisplatin, doxorubicin, etoposide, fluorouracil, mitomycin-C
                • Other agents: Powdered collagen, distilled water, povidone-iodine (Betadine), interferon-β
                • Physical pleural abrasion

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Sonoda A et al: Pleurodesis: indications and radiologic appearance. Jpn J Radiol. ePub, 2015
                                    2. Truong MT et al: PET/CT in the thorax: pitfalls. Radiol Clin North Am. 52(1):17-25, 2014
                                    3. Xia H et al: Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One. 9(1):e87060, 2014
                                    4. Choong CK: Management of benign and malignant pleural effusions. Thorac Surg Clin. 23(1):ix, 2013
                                    5. Nguyen NC et al: F-18 FDG PET/CT characterization of talc pleurodesis-induced pleural changes over time: a retrospective study. Clin Nucl Med. 34(12):886-90, 2009
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Synonyms

                                                • Pleural sclerosis
                                                • Talc poudrage
                                              • Definitions

                                                • Chemical pleural sclerosis to treat refractory malignant pleural effusion and spontaneous pneumothorax
                                                • Other indications
                                                  • Recurrent benign pleural effusions: Heart failure, ascites, systemic lupus erythematosus
                                                  • Recurrent pneumothorax: COPD, lymphangioleiomyomatosis, catamenial
                                                  • Chylothorax: Postsurgical, post-traumatic
                                                • Contraindications
                                                  • Infection, advanced heart disease, coagulation disorders
                                                • Pleurodesis agents and methods
                                                  • Pure talc (hydrated magnesium silicate)
                                                    • Most used/most effective sclerosant agent
                                                    • Highest success rate for malignant pleural effusion
                                                    • 4-8% risk of respiratory failure after talc exposure
                                                    • Side effects may be related to smaller particle size
                                                  • Bleomycin
                                                    • Readily available
                                                    • More expensive; must be used immediately
                                                  • Tetracycline and derivatives
                                                    • Doxycycline, minocycline
                                                    • Inexpensive, can be stored
                                                  • Chemotherapy agents: Cisplatin, doxorubicin, etoposide, fluorouracil, mitomycin-C
                                                  • Other agents: Powdered collagen, distilled water, povidone-iodine (Betadine), interferon-β
                                                  • Physical pleural abrasion

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • Nuclear Medicine Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Sonoda A et al: Pleurodesis: indications and radiologic appearance. Jpn J Radiol. ePub, 2015
                                                                      2. Truong MT et al: PET/CT in the thorax: pitfalls. Radiol Clin North Am. 52(1):17-25, 2014
                                                                      3. Xia H et al: Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One. 9(1):e87060, 2014
                                                                      4. Choong CK: Management of benign and malignant pleural effusions. Thorac Surg Clin. 23(1):ix, 2013
                                                                      5. Nguyen NC et al: F-18 FDG PET/CT characterization of talc pleurodesis-induced pleural changes over time: a retrospective study. Clin Nucl Med. 34(12):886-90, 2009