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(Chest. 1994;106:1771-1775.)
© 1994 American College of Chest Physicians

Intrapleural Talc for the Prevention of Recurrence in Benign or Undiagnosed Pleural Effusions

Francisco S. Vargas M.D., F.C.C.P.1; Jose Ribas C. Milanez M.D.1; Luiz Tarcisio B. Filomeno M.D.1; Angelo Fernandez M.D.1; Adib Jatene M.D.1; and Richard W. Light M.D., F.C.C.P.1

1 From the Instituto do Coração and the Hospital das Clinicas of the Faculty of Medicine of the University of Sao Paulo, Brazil, and the Department of Medicine of the Veterans Administration Medical Center, Long Beach, Calif, and the University of California Irvine

Chemical pleurodesis has become the preferred treatment for definitive management of malignant pleural effusions. The treatment of patients with recurrent benign or undiagnosed pleural effusions, however, remains a difficult clinical problem. Tetracycline has been widely used as a sclerosing agent, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents are needed. Talc was used for the first time in 1935, and subsequently there have been several reports documenting its effectiveness in the treatment of malignant pleural effusion and pneumothorax. The objective of this study is to present our experience with a low dose of aerosolized talc for controlling nonmalignant pleural effusions. Between May 1985 and October 1992, twenty-two patients underwent talc pleurodesis at the time of thoracoscopy for control of a nonmalignant effusion. The cause of the effusion was cirrhosis in six patients, systemic lupus erythematosus in two, chylothorax in five, and no diagnosis in nine patients. Follow-up has ranged from 18 days to 5 years. Only two patients (9 percent), one with cirrhosis and another with an undiagnosed pleural effusion, had a recurrence of the effusions. We conclude that the intrapleural administration of 2 g of aerosolized talc is an effective treatment for recurrent benign (including chylothorax) or undiagnosed pleural effusions.

Key Words: aerosolized talc • chylothorax • pleural effusion • pleurodesis

Submitted on November 29, 1993
Accepted on April 25, 1994




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