malignant pleural effusion
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Introduction
Also see pleural effusion
Etiology
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
More general terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
- ↑ 2.0 2.1 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: https://www.ncbi.nlm.nih.gov/pubmed/22610520
- ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/15998551
- ↑ 4.0 4.1 4.2 Huggins JT, Doelken P, Sahn SA. Intrapleural therapy. Respirology. 2011 Aug;16(6):891-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21672085
- ↑ 5.0 5.1 5.2 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: https://www.ncbi.nlm.nih.gov/pubmed/29164255 https://jamanetwork.com/journals/jama/article-abstract/2664042?
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/3027250
- ↑ Thomas JM, Musani AI. Malignant pleural effusions: a review Clin Chest Med. 2013 Sep;34(3):459-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23993817 Review.