[Therapeutic pleurodesis in spontaneous pneumothorax, malignant pleural effusion, heart insufficiency and chylothorax]

Abstract

Treatment with pleurodesis is employed in spontaneous pneumothorax, in pleural effusion due to neoplastic disease, intractable transudate and chylothorax. When this treatment is employed in spontaneous pneumothorax, randomized studies show a lower recurrence rate when drainage is supplemented by a sclerosing agent. Pleurodesis alone scarcely alters the recurrence rate in pneumothorax. Treatment with pleurodesis is well accepted in malignant pleural effusion. Several randomized studies show a response rate of 11% when thoracocentesis is employed alone whereas a response rate of 40% is obtained when pleural drainage is also employed. When a sclerosing agent is added to pleural drainage, the response rate rises to approximately 60% or more. No randomized studies of pleurodesis in congestive heart failure and chylothorax were found. Pleurodesis is not recommended in the treatment of congestive heart failure because of reports of development of contralateral pleural effusion after successful pleurodesis. In chylothorax, pleurodesis is the last resort.