DIAGNOSIS AND MANAGEMENT OF MALIGNANT PLEURAL EFFUSIONS

Approximately half of all patients with metastatic cancer develop mali gnant pleural effusions. Because the patients are already terminally i ll, these effusions can present Significant diagnos tic and therapeuti c challenges, Symptoms are either present at the time of diagnosis or develop subsequently in virtually all cases. The diagnosis is based on chest radiography followed by thoracentesis or thoracoscopy. Most mal ignant effusions are exudative and about one third are bloody, Cytolog y is positive for cancer cells in the initial pleural fluid specimens from 60% of patients who are ultimately shown to have malignant effusi ons. The remaining 40% require a repeat thoracentesis, pleural biopsy, thoracoscopy, or multiple procedures to prove the presence of cancer, Because the average life expectancy of a patient with a malignant ple ural effusion is about 6 months, it is important to ob tain a diagnosi s expeditiously and formulate a treatment plan that optimizes quality of life, Tube thoracostomy with chemical pleurodesis using doxycycline or bleomycin is the mainstay of current treatment and is about 85% ef fective,