Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: memo - Magazine of European Medical Oncology 4/2015

01.12.2015 | review

Malignant pleural effusion: pathogenesis, diagnosis, and management

verfasst von: MD, Prim., MSc, MBA Christian Geltner, MD, Prim., Assoc. Prof. Peter Errhalt

Erschienen in: memo - Magazine of European Medical Oncology | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten
share
TEILEN

Abstract

Pleural effusion is common in various diseases and especially malignant effusions can have rapid onset symptoms such as dyspnea, chest pain, and coughing. The diagnosis and the treatment approaches require several pleural techniques and knowledge about concomitant disease. In exudative effusions accompanying inflammatory reactions in pneumonia are the most common reasons. Malignant effusions are typically seen in lung and breast cancer patients. The differential diagnosis has to always include malignant pleural mesothelioma. The therapeutic approach is dependent on staging, symptoms, and prognosis of the underlying diseases. Techniques should include thoracocentesis, various chest drainages including indwelling permanent catheters and talc pleurodesis done by slurry instillation or by surgical approaches. This review addresses diagnosis options and treatment modalities including thoracocentesis, thoracoscopy, chest drainage, and indwelling catheters. Clear algorithms are presented.
Literatur
1.
Zurück zum Zitat Zocchi L. Physiology and pathophysiology of pleural fluid turnover. Eur Respir Mon. 2002; 22:28–49. Zocchi L. Physiology and pathophysiology of pleural fluid turnover. Eur Respir Mon. 2002; 22:28–49.
2.
Zurück zum Zitat Stathopoulos GT, Kalomenidis I. Malignant pleural effusion: tumor-host interactions unleashed. Am J Respir Crit Care Med. 2012;186:487–92. PubMedCrossRef Stathopoulos GT, Kalomenidis I. Malignant pleural effusion: tumor-host interactions unleashed. Am J Respir Crit Care Med. 2012;186:487–92. PubMedCrossRef
3.
Zurück zum Zitat Traill ZC, Davies RJO, Gleeson FV. Thoracic computed tomography in patients with suspected malignant pleural effusions. Clin Radiol. 2001;56:193–6. PubMedCrossRef Traill ZC, Davies RJO, Gleeson FV. Thoracic computed tomography in patients with suspected malignant pleural effusions. Clin Radiol. 2001;56:193–6. PubMedCrossRef
4.
Zurück zum Zitat Loddenkemper R. Prospective evaluation of biopsy methods in the diagnosis of malignant pleural effusion. Intrapatient comparison between pleural fluid cytology, blind needle biopsy, and thoracoscopy. Am Rev Respir Dis. 1983;127:114. Loddenkemper R. Prospective evaluation of biopsy methods in the diagnosis of malignant pleural effusion. Intrapatient comparison between pleural fluid cytology, blind needle biopsy, and thoracoscopy. Am Rev Respir Dis. 1983;127:114.
5.
7.
Zurück zum Zitat Geisel FL. Dynamic contrast enhanced MRI of malignant pleural mesothelioma: a feasibility study of non-invasive assessment, therapeutic follow-up, and possible predictor of improved outcome. Chest. 2006;129:1570–6. CrossRef Geisel FL. Dynamic contrast enhanced MRI of malignant pleural mesothelioma: a feasibility study of non-invasive assessment, therapeutic follow-up, and possible predictor of improved outcome. Chest. 2006;129:1570–6. CrossRef
8.
Zurück zum Zitat Hooper C. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii4–7. PubMed Hooper C. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii4–7. PubMed
9.
Zurück zum Zitat Ault MJ, Rosen BT, Scher J, Feinglass J, Barsuk JH. Thoracentesis outcomes: a 12-year experience. Thorax. 2015;70(2):127–132. PubMedCrossRef Ault MJ, Rosen BT, Scher J, Feinglass J, Barsuk JH. Thoracentesis outcomes: a 12-year experience. Thorax. 2015;70(2):127–132. PubMedCrossRef
10.
Zurück zum Zitat Garcia L. The value of multiple fluid specimens in the cytological diqgnosis of malignancy. Mod Pathol. 1994;7:665e8. Garcia L. The value of multiple fluid specimens in the cytological diqgnosis of malignancy. Mod Pathol. 1994;7:665e8.
11.
Zurück zum Zitat Loddenkemper R. Prospective evaluation of biopsy methods in the diagnosis of malignant pleural effusion. Intrapatient comparison between pleural fluid cytology, blind needle biopsy, and thoracoscopy. Am Rev Respir Dis. 1983;127:114. Loddenkemper R. Prospective evaluation of biopsy methods in the diagnosis of malignant pleural effusion. Intrapatient comparison between pleural fluid cytology, blind needle biopsy, and thoracoscopy. Am Rev Respir Dis. 1983;127:114.
12.
Zurück zum Zitat Astoul P. Pleurodesis for recurrent malignant pleural effusions: the quest for the Holy Grail. Eur J Cardiothorac Surg. 2011;40(2):277–9. PubMed Astoul P. Pleurodesis for recurrent malignant pleural effusions: the quest for the Holy Grail. Eur J Cardiothorac Surg. 2011;40(2):277–9. PubMed
13.
Zurück zum Zitat Tschopp J-M, Schnyder J-M, Froudarakis M. Astoul P. VATS or simple talc poudrage under medical thoracoscopy for recurrent spontaneous pneumothorax. Eur Respir J. 2011;33:442–3. CrossRef Tschopp J-M, Schnyder J-M, Froudarakis M. Astoul P. VATS or simple talc poudrage under medical thoracoscopy for recurrent spontaneous pneumothorax. Eur Respir J. 2011;33:442–3. CrossRef
15.
Zurück zum Zitat Roberts ME. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):32–40. Roberts ME. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):32–40.
16.
Zurück zum Zitat Sorensen PG, Svendsen TL, Enk B. Treatment of malignant pleural effusion with drainage, with and without instillation of talc. Eur J Respir Dis. 1984;65:131–5. PubMed Sorensen PG, Svendsen TL, Enk B. Treatment of malignant pleural effusion with drainage, with and without instillation of talc. Eur J Respir Dis. 1984;65:131–5. PubMed
17.
Zurück zum Zitat Hunt I, Teh E, Southon R, et al. Using non-steroidal anti-inflammatory drugs (NSAIDs) following pleurodesis. Interact Cardiovasc Thorac Surg. 2007;6:102–4. PubMedCrossRef Hunt I, Teh E, Southon R, et al. Using non-steroidal anti-inflammatory drugs (NSAIDs) following pleurodesis. Interact Cardiovasc Thorac Surg. 2007;6:102–4. PubMedCrossRef
18.
Zurück zum Zitat Danby CA, Adebonojo SA, Moritz DM. Video-assisted talc pleurodesis for malignant pleural effusions utilizing local anesthesia and I.V. sedation. Chest. 1998;113:739e42. CrossRef Danby CA, Adebonojo SA, Moritz DM. Video-assisted talc pleurodesis for malignant pleural effusions utilizing local anesthesia and I.V. sedation. Chest. 1998;113:739e42. CrossRef
19.
Zurück zum Zitat Astoul P. Pleurodesis for recurrent malignant pleural effusions: the quest for the Holy Grail. Eur J Cardiothorac Surg. 2011;40(2):277–9. PubMed Astoul P. Pleurodesis for recurrent malignant pleural effusions: the quest for the Holy Grail. Eur J Cardiothorac Surg. 2011;40(2):277–9. PubMed
20.
Zurück zum Zitat Parulekar W, Di Primio G, Matzinger F, et al. Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions. Chest. 2001;120:19e25. CrossRef Parulekar W, Di Primio G, Matzinger F, et al. Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions. Chest. 2001;120:19e25. CrossRef
21.
Zurück zum Zitat Musani AI. Treatment options for malignant pleural effusion. Curr Opin Pulm Med. 2009;15:380–7. PubMedCrossRef Musani AI. Treatment options for malignant pleural effusion. Curr Opin Pulm Med. 2009;15:380–7. PubMedCrossRef
22.
Zurück zum Zitat Warren WH, Kalimi R, Khodadadian LM, et al. Management of malignant pleural effusions using the PleurX catheter. Ann Thorac Surg. 2008;85:1049e55. Warren WH, Kalimi R, Khodadadian LM, et al. Management of malignant pleural effusions using the PleurX catheter. Ann Thorac Surg. 2008;85:1049e55.
23.
Zurück zum Zitat Loddenkemper R. Thoracoscopy: state of the art. Eur Respir J. 1998;11:213e21. CrossRef Loddenkemper R. Thoracoscopy: state of the art. Eur Respir J. 1998;11:213e21. CrossRef
24.
Zurück zum Zitat Harris RJ, Kavuru MS, Rice TW, et al. The diagnostic and therapeutic utility of thoracoscopy. A review. Chest. 1995;108:828e41. Harris RJ, Kavuru MS, Rice TW, et al. The diagnostic and therapeutic utility of thoracoscopy. A review. Chest. 1995;108:828e41.
25.
Zurück zum Zitat Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med 1991;114:271e6. CrossRef Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med 1991;114:271e6. CrossRef
26.
Zurück zum Zitat Tschopp JM. Pleurodesis by talc poudrage under simple medical thoracoscopy: an international opinion. Thorax. 2009;64(3):273–4. PubMedCrossRef Tschopp JM. Pleurodesis by talc poudrage under simple medical thoracoscopy: an international opinion. Thorax. 2009;64(3):273–4. PubMedCrossRef
27.
Zurück zum Zitat Arapis K, Caliandro R, Stern JB, et al. Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients. Surg Endosc. 2006;20:919e23. CrossRef Arapis K, Caliandro R, Stern JB, et al. Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients. Surg Endosc. 2006;20:919e23. CrossRef
28.
Zurück zum Zitat Hooper C. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii4–7. PubMed Hooper C. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii4–7. PubMed
29.
Zurück zum Zitat Roberts ME. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):32–40. Roberts ME. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):32–40.
Metadaten
Titel
Malignant pleural effusion: pathogenesis, diagnosis, and management
verfasst von
MD, Prim., MSc, MBA Christian Geltner
MD, Prim., Assoc. Prof. Peter Errhalt
Publikationsdatum
01.12.2015
Verlag
Springer Vienna
Erschienen in
memo - Magazine of European Medical Oncology / Ausgabe 4/2015
Print ISSN: 1865-5041
Elektronische ISSN: 1865-5076
DOI
https://doi.org/10.1007/s12254-015-0246-0