Malignant pleural effusions

Abstract

Pleural effusions are common in cancer patients, developing either from the malignant condition or from unrelated causes, such as congestive heart failure, pulmonary infarction, or infection. Diagnosis of malignant pleural effusion rests on demonstration of the presence of malignant cells in the pleural fluid or pleural biopsy specimen. Treatment is usually aimed at relief of symptoms rather than at the underlying malignancy. Specific therapeutic measures include thoracentesis, chest tube drainage, pleurodesis with chemicals or biologic agents, radiation and systemic chemotherapy, surgical pleurodesis, and pleuroperitoneal shunt. These should be supplemented by ancillary measures to maintain fluid and nutritional balance and prevent complications.

Treatment of pleural effusions and pneumothorax with catheters placed percutaneously under imaging guidance

“…The 86% we achieved in the final year of our study compares favorably with these results. The success rate for drainage of malignant effusions with surgically placed tubes ranges from 5% to 86%, with a mean of 42% [9]. Our success rate with percutaneously placed catheters was 63% for this subgroup.…”

Diagnostic and Therapeutic Pleuroscopy Using a Flexible Fiberoptic Bronchoscope for Resource-poor Environments: A Case Series

“…Previous studies revealed that for malignant effusion the diagnostic yield of the pleural fluid cytology can be as low as 30% and sometimes as high as 80%, [1][2][3][4][5] depending on the type of the tumour 6 and the degree of pleural involvement. 7 The standard closed pleural biopsy, done with the help of Abram's or Cope's needle has a diagnostic yield of only 50%-60% for combined tuberculosis and malignancy.…”

Pleural fluid cytology of Hodgkin's disease: Cytomorphologic features and the value of immunohistochemical studies

“…1,2 Benign causes of pleural effusion include congestive heart failure, pulmonary infarction, and hypoproteinemia due to malnutrition. 10 There are rare iatrogenic causes of pleural effusions in HD, including radiation therapy to the mediastinum and chemotherapy with methotrexate, cyclophosphamide, busulfan, and procarbazine. [10][11][12] The usual etiology for pleural effusion in HD is obstruction of lymphatic drainage in the mediastinum or lung, and direct pleural involvement.…”

“…10 There are rare iatrogenic causes of pleural effusions in HD, including radiation therapy to the mediastinum and chemotherapy with methotrexate, cyclophosphamide, busulfan, and procarbazine. [10][11][12] The usual etiology for pleural effusion in HD is obstruction of lymphatic drainage in the mediastinum or lung, and direct pleural involvement. Pleural effusion in primary pulmonary HD is uncommon, occurring in only 1 of 15 cases reported by Yousem et al, even though the majority had subpleural involvement.…”