Unilateral pulmonary edema after talc pleurodesis

Talc is commonly given after drainage of the pleural space to create pleura l symphysis. Recognized complications of pleural drainage followed by talc pleurodesis include reexpansion pulmonary edema, pneumonia, and adult respi ratory distress syndrome. This report describes a complication of talc pleu rodesis that appears not to have been appreciated previously. Chest radiogr aphs obtained before and after talc pleurodesis were evaluated in a total o f 108 patients in three groups; 89 of these patients were receiving palliat ive therapy for malignant pleural effusion. Approximately 16% of the 108 pa tients developed a transient interstitial process in the lungs ipsilateral to the treated pleural space. The recognized complications are inadequate t o account for these radiographic findings. Other interstitial diseases such as hydrostatic pulmonary edema and lymphangitic carcinomatosis also are no t adequate explanations. The observed complication is most likely the resul t of endothelial damage leading to a capillary leak type of pulmonary edema .