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Experimental Pleurodesis in Rabbits Induced by Silver Nitrate or Talc^*

1-Year Follow-up

^* From the Laboratory of Pleura (Drs. Vargas, Teixeira, Antonangelo, Vaz, Carmo, and Marchi), Division of Respiratory Diseases, Heart Institute (InCor), University of São Paulo Medical School, Brazil; and Department of Medicine of Saint Thomas Hospital and Vanderbilt University (Dr. Light), Nashville, TN.

Correspondence to: Richard W. Light, MD, FCCP, Director of Pulmonary Disease Program, Saint Thomas Hospital, 4220 Harding Rd, Nashville, TN 37205; e-mail: rlight98{at}yahoo.com

Study objective: To compare the pleurodesis results from the intrapleural injection of silver nitrate and talc slurry over an observation period of 12 months in rabbits.

Design: Rabbits were randomized to receive 2 mL of 0.5% silver nitrate or 400 mg/kg of talc slurry in 2 mL intrapleurally. Ten rabbits in each group were killed at 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, and 12 months after intrapleural injection. The degree of gross pleurodesis and the amount of microscopic pleural fibrosis and inflammation were graded on a scale of 0 to 4.

Results: The mean ± SEM gross pleurodesis score in the 70 rabbits that received silver nitrate was 3.34 ± 0.08, which was significantly higher than the score of 2.32 ± 0.09 in the 70 rabbits that received talc. The mean gross pleurodesis score was significantly higher at each of the observation times (p < 0.05), except at 2 months, in the rabbits that received silver nitrate. The pleurodesis was distributed throughout the thorax in the rabbits that received silver nitrate, while it was only in the ventral thorax in the rabbits that received talc slurry. The gross pleurodesis scores showed no tendency to decrease during the 12-month observation period in either treatment group. The persistence of talc in the pleural space did not lead to chronic inflammatory changes because the inflammation scores were similar in both groups at all observation times. The microscopic pleural fibrosis score tended to decrease with time in the silver nitrate group but not in the talc slurry group.

Conclusions: The intrapleural injection of 2 mL of 0.5% silver nitrate produces a better pleurodesis than does the intrapleural injection of 400 mg/kg of talc slurry in rabbits. The pleurodesis induced by silver nitrate persists for at least 1 year. The efficacy of silver nitrate as a sclerosing agent in humans should be evaluated.

Key Words: pleural effusion • pleurodesis • pneumothorax • silver nitrate • talc

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