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, remains 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 for the first time in 1935, and subsequently there have been several reports documenting its effectiveness in the treatment of
malignant pleural effusion and
pneumothorax. The objective of this study is to present our experience with a low dose of aerosolized
talc for controlling nonmalignant
pleural effusions. Between May 1985 and October 1992, twenty-two patients underwent
talc pleurodesis at the time of thoracoscopy for control of a nonmalignant effusion. The cause of the effusion was
cirrhosis in six patients,
systemic lupus erythematosus in two,
chylothorax in five, and no diagnosis in nine patients. Follow-up has ranged from 18 days to 5 years. Only two patients (9 percent), one with
cirrhosis and another with an undiagnosed
pleural effusion, had a recurrence of the effusions. We conclude that the intrapleural administration of 2 g of aerosolized
talc is an effective treatment for recurrent benign (including
chylothorax) or undiagnosed
pleural effusions.