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malignant pleural effusion

Also see pleural effusion Etiology: - lung cancer - breast cancer - lymphoma - metastatic cancer of unknown primary Management: - observation for asymptomatic unilateral pleural effusion - thoracentesis for palliation of symptomatic pleural effusion - may require repeated thoracentesis - avoid excessive drainage to prevent pulmonary edema following lung expansion - pleurodesis may be palliative, but often fails due to the presence of visceral pleural restriction [4] - outcomes of thoracentesis & pleurodesis similar [2] - indwelling pleural catheter is preferred approach [3,4] - no clear winner between pleural catheter & pleurodesis; both provide symptomatic benefit [5] - indwelling pleural catheters are a less-invasive approach associated with fewer hospital days, at the cost of more adverse events [5] - prognosis: average survival is 6 months

General

pleural effusion

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
  2. Davies HE et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: The TIME2 randomized controlled trial. JAMA 2012 Jun 13; 307:2383. PMID: 22610520
  3. van den Toorn LM1, Schaap E, Surmont VF Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter. Lung Cancer. 2005 Oct;50(1):123-7. PMID: 15998551
  4. Huggins JT, Doelken P, Sahn SA. Intrapleural therapy. Respirology. 2011 Aug;16(6):891-9. PMID: 21672085
  5. Thomas R, Fysh ETH, Smith NA et al. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion: The AMPLE randomized clinical trial. JAMA 2017 Nov 21; 318:1903. PMID: 29164255 https://jamanetwork.com/journals/jama/article-abstract/2664042?
  6. Feller-Kopman DJ, Reddy CB, DeCamp MM et al Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Oct 1;198(7):839-849 PMID: 3027250
  7. Thomas JM, Musani AI. Malignant pleural effusions: a review Clin Chest Med. 2013 Sep;34(3):459-71. PMID: 23993817 Review.