Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion: Report of 16 cases and review of the literature

Background: Chemical pleurodesis is an effective treatment for malignant pleural effusion and pneumothorax. This mode of therapy is, however, less widely accepted in the treatment of patients with refractory benign or undiagnosed pleural effusion. Study objectives: To analyze the outcome of tale slurry pleurodesis in patients with nonmalignant pleural effusions. Design: Retrospective and partly prospective analysis of clinical outcome. Setting: Hadassah University Hospital, Jerusalem, Israel. Patients and participants: Between 1992 and 1997, we treated 16 patients with nonmalignant pleural effusion using tale slurry pleurodesis. The cause of effusion was congestive heart failure in 6 patients, liver cirrhosis in 4 patients, yellow nail syndrome in 1 patient, systemic lupus erythematosus in 1 patient, chylothorax in 1 patient, and undiagnosed in 3 patients. Interventions: Nine patients were hospitalized, and seven patients received treatment in a day- care setting. Follow-up ranged from 2 months to 3 years. Results: Complete success was observed in 12 eases (75%), partial success in 3 eases (19%), and pleurodesis was ineffectual in 1 case (6%). There were no significant complications after the procedure in any of our patients. A review of the English-language medical literature revealed an additional 110 reported eases of nonmalignant pleural effusion that were treated with chemical pleurodesis. Of these cases, tale was used in 65% with a success rate of nearly 100%. Conclusions: Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. This procedure is safe and easily performed and, in selected cases, can be performed in an outpatient day-care setting.