Pleurodesis is a procedure that involves the administration of an agent into the pleural space to cause adhesion to the chest wall (usually from adhesion between the parietal and the visceral layers of the pleura). Usually an irritative chemical agent (chemical pleurodesis) and rarely microbiological and mechanical methods are used.
Indication
It can be used in a number of situation including:
development of chronic/recurrent pneumothoraces
development of chronic/recurrent pleural effusions
Agents
Various agents have been used which include:
-
talc - talc pleurodesis
one of the most commonly used
usually around 2.5-10 mg
general anesthesia required if instilled by powder; anecdotal reports of pneumonitis and acute respiratory distress syndrome (ARDS)
-
tetracycline class antibiotics
-
minocycline
usually around (300 mg)
-
doxycycline
tends to requires multiple doses
tetracycline
-
Corynebacterium parvum - Corynebacterium parvum pleurodesis
mepacrine
bleomycin
povidone-iodine
quinacrine hydrochloride (Atabrine)
Radiographic features
Chest radiography
pleural thickening with or without small effusions
mediastinal shift to the same side of pleurodesis
high attenuation material in the apical or posterior costophrenic angle
CT
pleurodesis may not be identifiable in small and post-autologous sclerotic pleurodesis
diffuse or nodular (single or multiple) plaque-like pleural thickening
high-attenuation sclerosing agent, e.g. talc, or surgical staples in mechanical pleurodesis
residual small effusions
PET/CT
Caution must be exercised when interpeting the studies of patients with post-malignant effusion pleurodesis as there may be increased FDG uptake in talc particles.