Definition & Overview
A pleurodesis is a medical procedure used to treat pleural effusion particularly in patients with lung cancer or mesothelioma (asbestos-related cancer that forms on the lungs' protective tissues). Pleural effusion is a condition in which excess fluid builds up around or next to the lung causing breathing difficulties and other symptoms. It is this fluid that pleurodesis aims to drain so patients can experience relief from their symptoms. However, the procedure does not cure or treat underlying medical conditions that cause pleural effusion.
Pleurodesis can now be performed using a variety of techniques, including video-assisted thoracoscopy, which has made the procedure less invasive than it traditionally was so it is safer and easier to recover from.
Who Should Undergo and Expected Results
Pleurodesis is indicated for patients suffering from pleural effusion or the abnormal buildup of excess fluid around the lungs. Pleura, or the thin membrane that lines the inside of the chest wall just outside the lungs, has some watery fluid allowing lungs to move during respiration. However, when there is too much liquid in this area, the lungs cannot fully expand when the patient breathes, resulting in a variety of symptoms including:
- Shortness of breath
- Chest pain
- Pleurisy or pleuritic pain, which occurs when the patient breathes in deeply
Pleural effusion, which can be diagnosed through an X-ray, ultrasound, or CT scan, is linked with several medical conditions, including:
- Liver cirrhosis
- Pulmonary embolism
- Congestive heart failure
- End-stage renal disease
- Other autoimmune diseases
Pleurodesis can be used to treat both uncomplicated and complicated cases of pleural effusions. Complicated cases are those in which the fluid in the pleural space contains some inflammation or infection, which can eventually impair breathing. It can also effectively treat recurrent effusions, which can significantly compromise the quality of life of affected patients.
Aside from draining fluid from the pleural space, pleurodesis is also effective in preventing recurrences and is successful in as much as 70% of cases.
Despite the availability of other treatment options, pleurodesis is the most commonly used treatment for pleural effusions and is considered as the best palliative treatment for the condition. It is more effective compared to thoracentesis, or when the fluid is drained without sealing the pleural space.
How is the Procedure Performed?
Pleurodesis is performed under general anaesthesia as an inpatient procedure, which means the patient is asleep all throughout and has to stay in the hospital overnight. During the procedure, medications and other fluids are given through an IV line placed in the arm.
If video-assisted thoracoscopy is used, the surgeon will make one or two tiny incisions on the side of the body where the thoracoscope and other instruments are inserted. These include a camera that captures images while inside the surgical site and projects them on a video monitor. The images provide guidance as the fluid is drained from the pleura.
An irritant drug is then introduced into the pleural space. This drug, which is usually the liquid form of sterile medical talc, is administered into the pleural space to make the lung stick to the wall of the chest. Once the drug is injected, the chest drain is closed off to make sure the drug stays in place. It is reopened after an hour to allow more fluid to drain out.
After the procedure, the incisions are closed up with a few stitches, if necessary, and a dressing is placed over them to protect the wounds as they heal. The dressing is left in place for up to 48 hours. During this time, patients are advised against taking any anti-inflammatory drug.
Possible Risks and Complications
While complications following pleurodesis are rare, the procedure does have some risks, such as:
- Inflammation in the lungs, which can either resolve within a few days when treated with oxygen or can cause serious or even fatal effects
- Infection, mainly due to the tube inserted into the chest
- Malignant growth at the site of tube insertion, which usually occurs as a type of metastasis in patients already suffering from malignancy
Two rare but possible complications, namely cardiovascular complications and adult respiratory distress syndrome, may also occur.
Some patients may also suffer from chest pain or fever, both of which may occur within the first two days after the procedure and are easily resolved with paracetamol intake. The fever is caused by the inflammatory response that helps close the pleural space and usually develops between 4 and 12 hours after the procedure.
References : * Vaz MC, Marchi E, Vargas FS. “J Bras Pneumol. 2006 July/Aug. Vol. 32 no. 4. http://www.scielo.br/scielo.php?pid=S1806-37132006000400014&script=sci_arttext&tlng=en
- Chen J, Li Z, Xu N, Zhang X, Wang Y, Lin D. “Efficacy of medical thoracoscopic talc pleurodesis in malignant pleural effusion caused by different types of tumors and different pathological classifications of lung cancer.” Int J Clin Exp Med. 2015; 8(10): 18945-18953.