INTRAPLEURAL TALC FOR THE PREVENTION OF RECURRENCE IN BENIGN OR UNDIAGNOSED PLEURAL EFFUSIONS

Chemical pleurodesis has become the preferred treatment for definitive management of malignant pleural effusions. The treatment of patients with recurrent benign or undiagnosed pleural effusions, however, remai ns a difficult clinical problem. Tetracycline has been widely used as a sclerosing agent, but parenteral tetracycline is no longer available . Therefore, alternative sclerosing agents are needed. Talc was used f or the first time in 1935, and subsequently there have been several re ports documenting its effectiveness in the treatment of malignant pleu ral effusion and pneumothorax. The objective of this study is to prese nt our experience with a low dose of aerosolized talc for controlling nonmalignant pleural effusions. Between May 1985 and October 1992, twe nty-two patients underwent talc pleurodesis at the time of thoracoscop y for control of a nonmalignant effusion. The cause of the effusion wa s cirrhosis in six patients, systemic lupus erythematosus in two, chyl othorax in five, and no diagnosis in nine patients. Follow-up has rang ed from 18 days to 5 years. Only two patients (9 percent), one with ci rrhosis and another with an undiagnosed pleural effusion, had a recurr ence of the effusions. We conclude that the intrapleural administratio n of 2 g of aerosolized talc is an effective treatment for recurrent b enign (including chylothorax) or undiagnosed pleural effusions.