What Type of Procedure is a Pleurodesis?

Pleurodesis Indications, Procedure, and Complications

diagram of the lungs
A pleurodesis is a procedure often done for pleural effusions. istockphoto.com

Pleurodesis is a procedure sometimes performed for people with lung cancer and other conditions. What is this procedure and when is it done?

Pleurodesis – The Definition

Pleurodesis is a procedure that is designed to get the 2 layers of the lung lining (the pleura) to stick together. This works to obliterate the space between the layers (the pleural cavity) so that fluid (water, blood, or pus) can no longer build up between the layers.

Pleurodesis Procedure

In a pleurodesis a chemical is injected between the 2 pleural layers via a chest tube. These chemicals then cause inflammation which in turn causes scarring. This scarring pulls and holds the 2 membranes together so that fluid or air can no longer build up and collect in the space. The inner pleural lining is called the visceral pleura, and the outside pleural membrane is called the parietal pleura. Depending upon the underlying condition the procedure may be done through a small incision (video-assisted thoracoscopy or VATS) or a thoracotomy (open lung surgery.)

There are 2 types of pleurodesis, often used together:

  • Mechanical pleurodesis causes inflammation and scarring by mechanically rubbing the parietal (outside) pleura with gauze.
  • Chemical pleurodesis involves injecting a chemical (most often talc) between the pleural membranes to create inflammation and scarring (fibrosis.)

    Reasons a Pleurodesis May be Performed

    There are several conditions for which a pleurodesis may be done, which in turn result from medical conditions such as lung cancer, mesothelioma, cystic fibrosis, and other illnesses.

    • Malignant pulmonary effusion – Patients with lung cancer and metastatic cancer to the lung may develop a malignant pleural effusion--a pleural effusion which contains cancer cells. When this is the case there are 2 options. One is to do a thoracentesis and place a stent that will continually drain the fluid in the effusion to another part of the body (an indwelling pleural catheter or tunneled pleural catheter.) The other is pleurodesis.  

    Before a Pleurodesis

    Before a pleurodesis is performed, physicians consider several things. Most importantly, it’s important that removing the pleural fluid results in an improvement of symptoms (decreased shortness of breath.)  In addition to this, some physicians recommend the procedure only if life expectancy is greater than 1 month.

    Complications

    In general, a pleurodesis procedure is well tolerated. For a certain percentage of people, the procedure will be ineffective and further treatment with an indwelling catheter to drain the fluid, or a pleurectomy (removal of the pleural) will be needed. Another concern, for people who may have a lung transplant in the future, is that a previous pleurodesis can make this procedure more difficult.

    Example: Frank's lung cancer was causing recurrent pleural effusions, so his doctor recommended that he have a procedure called pleurodesis.

    Sources:

    Davies, H. et al. Effect of an Indwelling Pleural Catheter vs Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients With Malignant Pleural Effusions. The TIME2 Randomized Controlled Trial. JAMA. 2012. 307(22):2383-2389.

    Fortin, M., and A. Tremblay. Pleural controversies: indwelling pleural catheter vs pleurodesis for malignant pleural effusions. Journal of Thoracic Disease. 2015. 7(6):1052-7.

    Lenker, A., Mayer, D., and S. Bernard. Interventions to Treat Malignant Pleural Effusions. Clinical Journal of Oncology Nursing. 2015. 19(5):501-504.

    Loyola University Chicago School of Medicine. Pleurodesis. Accessed 09/29/15. http://www.meddean.luc.edu/lumen/MedEd/elective/pulmonary/pleurodesis/pleurod_f.htm

    Thomas, J., and A. Musani. Malignant pleural effusions: a review. Clinics in Chest Medicine. 2013. 34(3):459-71.

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