Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion - Report of 16 cases and review of the literature

Background: Chemical pleurodesis is an effective treatment for malignant pl eural effusion and pneumothorax. This mode of therapy is, however, less wid ely accepted in the treatment of patients with refractory benign or undiagn osed pleural effusion. Study objectives: To analyze the outcome of talc slurry pleurodesis in pati ents with nonmalignant pleural effusions. Design: Retrospective and partly prospective analysis of clinical outcome. Setting: Hadassah University Hospital, Jerusalem, Israel. Patients and participants: Between 1992 and 1997, we treated 16 patients wi th nonmalignant pleural effusion using talc slurry pleurodesis. The cause o f effusion was congestive heart failure in 6 patients, liver cirrhosis in 4 patients, yellow nail syndrome in 1 patient, systemic lupus erthematosus i n 1 patient, chylothorax in 1 patient, and undiagnosed in 3 patients. Interventions: Nine patients were hospitalized, and seven patients received treatment in a clay-care setting. Follow-up ranged from 2 months to 3 year s. Results: Complete success was observed in 12 cases (75%), partial success i n 3 cases (19%), and pleurodesis was ineffectual in 1 case (6%). There were no significant complications after the procedure in any of our patients. A review of the English-language medical literature revealed an additional 1 10 reported cases of nonmalignant pleural effusion that were treated with c hemical pleurodesis. Of these cases, talc was used in 65% with a success ra te of nearly 100%. Conclusions: Chemical pleurodesis, and specifically talc slurry, is an effe ctive treatment for recurrent benign or undiagnosed pleural effusion. This procedure is safe and easily performed and, in selected cases, can be perfo rmed in an outpatient day-care setting.