Pleural FDG Uptake More Than a Decade after Talc Pleurodesis

Abstract

Talc pleurodesis induces a strong local inflammatory reaction which can be detected by PET scan for years after the procedure. When patients undergo PET scanning in the workup of a suspected malignancy later in life, pleural FDG uptake may unnecessarily lead to an additional invasive diagnostic workup. We present two cases of positive pleural PET findings more than 10 years after talc pleurodesis, where we adopted a watchful waiting approach. Positive pleural PET findings as a result of prior talc pleurodesis should always be included in the differential diagnosis of pleural abnormalities.

Persistent Inflammation in Pulmonary Granuloma 48 Years after Talcage Pleurodesis, Detected by FDG-PET/CT

“…Peek et al for example, described increased FDG uptake 10 and 11 years, respectively, after talc pleurodesis. Follow up was done without histological proof, but by CT, which showed no signs of malignancy after 16 months [12]. …”

Efficacy of Tigecycline Pleurodesis: A Comparative Experimental Study

“…Talc is not biodegradable and is responsible for long-term persistent pleural inflammation that can be detected by PET scan many years after the procedure [35,36]. A possible advantage of tigecycline pleurodesis is the biodegradability of the molecule that might be administered several times, reaching a dosage level < 25 mg/kg.…”

Management of the Patient with a Malignant Pleural Effusion

“…10,35,[70][71][72] Also of note, talc increases F-18 FDG uptake on positron emission tomography, which can simulate pleural malignancies with imaging abnormalities persisting for up to 10 years. 73,74 Pleurodesis by either talc slurry via a chest catheter or insufflation via thoracoscopy have equal risks for respiratory complications, which are now considered unrelated to talc dose. 2,10 The etiology of respiratory complications is not known, but talc's small particle size allows its systemic absorption and distribution to vascular beds beyond the pleural space, which can induce tissue inflammation.…”