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Malignant pleural effusion: pathogenesis, diagnosis, and management

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Abstract

Pleural effusion is common in various diseases and especially malignant effusions can have rapid onset symptoms such as dyspnea, chest pain, and coughing. The diagnosis and the treatment approaches require several pleural techniques and knowledge about concomitant disease. In exudative effusions accompanying inflammatory reactions in pneumonia are the most common reasons. Malignant effusions are typically seen in lung and breast cancer patients. The differential diagnosis has to always include malignant pleural mesothelioma. The therapeutic approach is dependent on staging, symptoms, and prognosis of the underlying diseases. Techniques should include thoracocentesis, various chest drainages including indwelling permanent catheters and talc pleurodesis done by slurry instillation or by surgical approaches. This review addresses diagnosis options and treatment modalities including thoracocentesis, thoracoscopy, chest drainage, and indwelling catheters. Clear algorithms are presented.

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References

  1. Zocchi L. Physiology and pathophysiology of pleural fluid turnover. Eur Respir Mon. 2002; 22:28–49.

  2. Stathopoulos GT, Kalomenidis I. Malignant pleural effusion: tumor-host interactions unleashed. Am J Respir Crit Care Med. 2012;186:487–92.

    Article  PubMed  Google Scholar 

  3. Traill ZC, Davies RJO, Gleeson FV. Thoracic computed tomography in patients with suspected malignant pleural effusions. Clin Radiol. 2001;56:193–6.

    Article  PubMed  CAS  Google Scholar 

  4. Loddenkemper R. Prospective evaluation of biopsy methods in the diagnosis of malignant pleural effusion. Intrapatient comparison between pleural fluid cytology, blind needle biopsy, and thoracoscopy. Am Rev Respir Dis. 1983;127:114.

    Google Scholar 

  5. Maskell NA, Butland RJA. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003;58(Suppl 2):ii8–i17.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Niemann T, Egelhof T, Bongartz G. Transthoracic sonography for the detection of pulmonary embolism—a meta-analysis. Ultraschall Med. 2009;30(2):150–6. doi:10.1055/s-2008-1027856.

    Article  PubMed  CAS  Google Scholar 

  7. Geisel FL. Dynamic contrast enhanced MRI of malignant pleural mesothelioma: a feasibility study of non-invasive assessment, therapeutic follow-up, and possible predictor of improved outcome. Chest. 2006;129:1570–6.

    Article  Google Scholar 

  8. Hooper C. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii4–7.

    PubMed  Google Scholar 

  9. Ault MJ, Rosen BT, Scher J, Feinglass J, Barsuk JH. Thoracentesis outcomes: a 12-year experience. Thorax. 2015;70(2):127–132.

    Article  PubMed  Google Scholar 

  10. Garcia L. The value of multiple fluid specimens in the cytological diqgnosis of malignancy. Mod Pathol. 1994;7:665e8.

    Google Scholar 

  11. Loddenkemper R. Prospective evaluation of biopsy methods in the diagnosis of malignant pleural effusion. Intrapatient comparison between pleural fluid cytology, blind needle biopsy, and thoracoscopy. Am Rev Respir Dis. 1983;127:114.

    Google Scholar 

  12. Astoul P. Pleurodesis for recurrent malignant pleural effusions: the quest for the Holy Grail. Eur J Cardiothorac Surg. 2011;40(2):277–9.

    PubMed  Google Scholar 

  13. Tschopp J-M, Schnyder J-M, Froudarakis M. Astoul P. VATS or simple talc poudrage under medical thoracoscopy for recurrent spontaneous pneumothorax. Eur Respir J. 2011;33:442–3.

    Article  Google Scholar 

  14. Light RW. The Light criteria: the beginning and why they are useful 40 years later. Clin Chest Med. 2013;34(1):21–6. doi:10.1016/j.ccm.2012.11.006.

    Article  PubMed  Google Scholar 

  15. Roberts ME. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):32–40.

    Google Scholar 

  16. Sorensen PG, Svendsen TL, Enk B. Treatment of malignant pleural effusion with drainage, with and without instillation of talc. Eur J Respir Dis. 1984;65:131–5.

    PubMed  CAS  Google Scholar 

  17. Hunt I, Teh E, Southon R, et al. Using non-steroidal anti-inflammatory drugs (NSAIDs) following pleurodesis. Interact Cardiovasc Thorac Surg. 2007;6:102–4.

    Article  PubMed  Google Scholar 

  18. Danby CA, Adebonojo SA, Moritz DM. Video-assisted talc pleurodesis for malignant pleural effusions utilizing local anesthesia and I.V. sedation. Chest. 1998;113:739e42.

    Article  Google Scholar 

  19. Astoul P. Pleurodesis for recurrent malignant pleural effusions: the quest for the Holy Grail. Eur J Cardiothorac Surg. 2011;40(2):277–9.

    PubMed  Google Scholar 

  20. Parulekar W, Di Primio G, Matzinger F, et al. Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions. Chest. 2001;120:19e25.

    Article  Google Scholar 

  21. Musani AI. Treatment options for malignant pleural effusion. Curr Opin Pulm Med. 2009;15:380–7.

    Article  PubMed  Google Scholar 

  22. Warren WH, Kalimi R, Khodadadian LM, et al. Management of malignant pleural effusions using the PleurX catheter. Ann Thorac Surg. 2008;85:1049e55.

    Google Scholar 

  23. Loddenkemper R. Thoracoscopy: state of the art. Eur Respir J. 1998;11:213e21.

    Article  Google Scholar 

  24. Harris RJ, Kavuru MS, Rice TW, et al. The diagnostic and therapeutic utility of thoracoscopy. A review. Chest. 1995;108:828e41.

    Google Scholar 

  25. Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med 1991;114:271e6.

    Article  Google Scholar 

  26. Tschopp JM. Pleurodesis by talc poudrage under simple medical thoracoscopy: an international opinion. Thorax. 2009;64(3):273–4.

    Article  PubMed  CAS  Google Scholar 

  27. Arapis K, Caliandro R, Stern JB, et al. Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients. Surg Endosc. 2006;20:919e23.

    Article  Google Scholar 

  28. Hooper C. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii4–7.

    PubMed  Google Scholar 

  29. Roberts ME. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):32–40.

    Google Scholar 

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Authors and Affiliations

  1. Department of Pulmonology, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Austria

    Christian Geltner MD, Prim., MSc, MBA

  2. Department of Pulmonology, Universitätsklinikum Krems, Mitterweg 10, AT-3500 Krems, Austria

    Peter Errhalt MD, Prim., Assoc. Prof.

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  1. Christian Geltner MD, Prim., MSc, MBA
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  2. Peter Errhalt MD, Prim., Assoc. Prof.
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Correspondence to Christian Geltner MD, Prim., MSc, MBA.

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Geltner, C., Errhalt, P. Malignant pleural effusion: pathogenesis, diagnosis, and management. memo 8, 235–241 (2015). https://doi.org/10.1007/s12254-015-0246-0

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