Editing Pleural effusions (section)

== '''Management of malignant and paramalignant pleural effusions''' ==
{| class="wikitable"
|'''Option'''
|'''Comment'''
|-
|Observation
|For asymptomatic effusions; most will progress and require therapy
|-
|Therapeutic thoracentesis
|Prompt relief of dyspnea; most effusions recur unless underlying tumor responds to chemo- or radiotherapy
|-
|Chest catheter drainage only
|Most effusions will recur after catheter removal
|-
|Chest catheter drainage with chemical pleurodesis (eg, talc slurry)
|Variable response rate with 60 to 90 percent of patients responding to talc pleurodesis
|-
|Thoracoscopy with talc insufflation
|Control of effusion with similar frequency as chest catheter drainage with talc pleurodesis
|-
|Long-term indwelling pleural catheter
|Control of effusion and improved symptoms in most patients. Some patients may experience pleurodesis after two weeks (median 11 weeks) of catheter drainage, which allows catheter removal.
|-
|Long-term indwelling pleural catheter with talc instillation
|Control of effusion and symptoms with successful pleurodesis in 43 percent of patients without hospitalization
|-
|Pleural abrasion or pleurectomy
|Requires thoracoscopy or thoracotomy. Effectively controls effusions in nearly all patients.
|-
|Pleuroperitoneal shunt
|When other options have failed or are not indicated; may be useful for chylothorax
|-
|Chemotherapy
|May be effective in some tumor types, such as breast cancer, lymphoma, and small cell lung cancer
|-
|Radiotherapy
|Mediastinal radiation therapy may be effective in lymphoma and lymphomatous chylothorax
|}



Traditional criteria for indwelling pleural catheter removal - <50mL drainage for three consecutive days

[[Category:Thoracics]]
[[Category:Intern education]]