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Chest
Diagnosis
Post-Treatment Chest
Surgical Procedures and Complications
Pleurodesis
Pleurodesis
John P. Lichtenberger, III, MD
;
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 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
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
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 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
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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