Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

Pleural Tumors 1185

■Pleurodesis

➣Indication: recurrent effusion with symptoms

➣Contraindication: mediastinal shift toward effusion usually

means lung can’t expand and pleurodesis will fail

➣Complications: pain; loculations; ARDS with talc

➣Efficacy: 70–90% in selected patients; talc > doxycycline >

bleomycin

➣Most common cause of failure is incomplete drainage of effusion

■Technique

➣tube thoracostomy

➣wait for apposition of pleural surfaces (if not apposed, can’t

adhere)

➣volume of drainage not important

➣sedation/analgesia with opiates

➣inject sclerosing agent+saline

➣clamp tube x 2 hours

➣positional rotation may be important for talc

■Other measures

➣pleuroperitoneal shunt

➣serial therapeutic thoracenteses

➣pleurectomy

specific therapy

Malignant Mesothelioma

■Surgery+Chemotherapy+Radiotherapy

■Immunotherapy

■Palliation: pleurodesis, pleurectomy, pain control

Benign Fibrous Mesothelioma

■Resection

Primary Effusion Lymphoma

■Chemotherapy for lymphoma

Metastatic Pleural Disease

■Chemotherapy for primary

■If positive cytology without obvious primary – get CT scan of chest,

abdomen, pelvis, and mammogram, since 75% originate from lung,

breast, lymphoma

■Pleurodesis