Pleurodesis

The lung is wrapped in two thin layers, like a balloon inside a plastic bag. Normally only a spoonful of fluid sits between them. When fluid builds up in that space, it is called a pleural effusion. It squeezes the lung and makes you short of breath.

Draining the fluid with a needle, called thoracentesis, gives quick relief. But when the cause is cancer, or sometimes heart or liver disease, the fluid often returns within days or weeks. Repeated needle drains become tiring. Pleurodesis makes the two layers stick together so there is no space left for fluid to collect.

On a chest X-ray, fluid shows as a white area at the bottom of the lung with a curved top edge. After a good drainage, the lung expands and the black, air-filled lung reaches the chest wall again.

Both work well, and large studies show similar improvement in breathing. The catheter means fewer days in the hospital. Over weeks to months, about a third to a half of people with a catheter find that the space seals on its own and the tube can be removed. Talc can also be given through a catheter to speed that up. Learn more on the PleurX catheter and chest PleurX pages.

If draining the fluid did not help your breathing, neither option is likely to help, and we will look for another cause of breathlessness.

Talc can also be sprayed during a keyhole chest procedure done by a surgeon or lung specialist, called thoracoscopy. Here we describe the bedside method through a chest tube, called talc slurry.

1. 1
   Placing a chest tube

   With numbing medicine and often light sedation, we use ultrasound to place a small tube between the ribs into the fluid. You feel pressure but should not feel sharp pain.

2. 2
   Draining and checking

   The fluid drains over hours to a day or two. A chest X-ray confirms that the lung has fully expanded and the two layers are touching.

3. 3
   Giving the talc

   Sterile talc mixed with saline is passed through the tube, usually after a numbing medicine. The tube is clamped for about an hour so the talc coats the space.

4. 4
   Tube removal

   The tube is reopened to drain. Once very little fluid comes out, usually in 1–3 days, the tube is removed and you go home.

1. First 1–2 days
   Chest pain and a low fever are common after talc as the layers become inflamed. That inflammation is what seals them. We give regular pain medicine.
2. Days 2–5
   The tube comes out once drainage slows. A small dressing covers the site. You go home.
3. First week at home
   Keep the dressing dry for 48 hours, then shower normally. Avoid heavy lifting for about a week.
4. 2–4 weeks
   A follow-up chest X-ray checks that the fluid has not returned.

Talc pleurodesis stops the fluid from returning in roughly 7 to 8 out of 10 people when the lung fully expands. If it fails, a home catheter is usually the next step.

The single most important thing I look at is whether your lung fully re-expands once the fluid is out. If it does, talc has a good chance of solving the problem for good. If it stays trapped, I recommend a home catheter, because talc cannot seal a space that will not close. Either way, my aim is to get you breathing comfortably and out of the hospital quickly.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos