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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 recurrent pneumothorax
- Other indications
- Recurrent benign pleural effusions: Heart failure, ascites, systemic lupus erythematosus
- Recurrent pneumothorax: Chronic obstructive pulmonary disease, lymphangioleiomyomatosis, catamenial
- Chylothorax: Postsurgical, post-traumatic
- Contraindications
- Infection, advanced heart disease, coagulation disorders, planned lung transplant
- 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
- Pure talc (hydrated magnesium silicate)
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
- Jun JK et al: Pleural talcomas present pitfalls in workup of pleural masses. J Med Imaging Radiat Oncol. 63(3):355, 2019
- Hobbs SB et al: Nodular pleural thickening after lobectomy for lung cancer. insights on imaging of the pleura. Ann Am Thorac Soc. 13(8):1424-5, 2016
- Sonoda A et al: Pleurodesis: indications and radiologic appearance. Jpn J Radiol. 33(5):241-5, 2015
- Truong MT et al: PET/CT in the thorax: pitfalls. Radiol Clin North Am. 52(1):17-25, 2014
- Xia H et al: Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One. 9(1):e87060, 2014
- Choong CK: Management of benign and malignant pleural effusions. Thorac Surg Clin. 23(1):ix, 2013
- 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
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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 recurrent pneumothorax
- Other indications
- Recurrent benign pleural effusions: Heart failure, ascites, systemic lupus erythematosus
- Recurrent pneumothorax: Chronic obstructive pulmonary disease, lymphangioleiomyomatosis, catamenial
- Chylothorax: Postsurgical, post-traumatic
- Contraindications
- Infection, advanced heart disease, coagulation disorders, planned lung transplant
- 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
- Pure talc (hydrated magnesium silicate)
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
- Jun JK et al: Pleural talcomas present pitfalls in workup of pleural masses. J Med Imaging Radiat Oncol. 63(3):355, 2019
- Hobbs SB et al: Nodular pleural thickening after lobectomy for lung cancer. insights on imaging of the pleura. Ann Am Thorac Soc. 13(8):1424-5, 2016
- Sonoda A et al: Pleurodesis: indications and radiologic appearance. Jpn J Radiol. 33(5):241-5, 2015
- Truong MT et al: PET/CT in the thorax: pitfalls. Radiol Clin North Am. 52(1):17-25, 2014
- Xia H et al: Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One. 9(1):e87060, 2014
- Choong CK: Management of benign and malignant pleural effusions. Thorac Surg Clin. 23(1):ix, 2013
- 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
