Skip to Main Content


Malignant pleural effusion is a common clinical problem in neoplastic diseases. Approximately half of all patients with metastatic cancer develop a malignant pleural effusion as a consequence of their disease.1 Although there have been no epidemiologic studies, the annual incidence of malignant pleural effusion in the United States is estimated to be more than 150,000 cases.2 The main problem that patients who develop such effusions experience is a reduction in the quality of life owing to symptoms such as dyspnea, chest pain (primarily related to involvement of the parietal pleura and chest wall), and cough.


Treatment options for malignant pleural effusions are determined by the symptoms and performance status of the patient, the primary tumor and its response to systemic therapy, lung reexpansion after pleural fluid evacuation, and expected survival. The therapeutic goal of palliative treatment is permanent resolution of the pleural effusion. For patients who are symptomatic from pleural effusions, dramatic improvement or complete resolution of symptoms with remaining or limited recurrence of the effusion can be called a partial success. It always must be remembered that controlling a malignant pleural effusion is a local phenomenon that has no effect on the underlying systemic disease.


A number of different techniques have been used over the past 20 years. The most common method is pleurodesis (i.e., obliteration of the pleural space), effected by instilling a chemical sclerosant in the pleural space after the effusion has been drained completely, either during thoracoscopy (under sedation or general anesthesia) or at bedside thoracostomy.1,3 There is no single unified approach to thoracoscopy. It can be performed by using flexible or rigid scopes with or without video assistance under local, regional, or general anesthesia and with or without selective one-lung ventilation.4 It provides access to the entire pleural cavity, permits biopsy under direct visualization, and by means of a video-assisted procedure, enables optimal preparation of the pleural surface and homogeneous distribution of the sclerosing agent under visual control, thereby maximizing the chances for complete pleurodesis.5,6


Malignancy always must be in the differential diagnosis of an undiagnosed unilateral or bilateral pleural effusion, and a thoracentesis must be performed. Complete drainage of the effusion is important for evaluating the underlying lung. If the lung remains collapsed after drainage, it usually indicates trapped lung syndrome. Options in cases involving trapped lung are tailored to the individual patient and include either implantation of a chronic indwelling pleural catheter (PleurX catheter, Denver Biomedical, Inc., Golden, CO),7,8 internal drainage from the pleura to peritoneum using a Denver pleuroperitoneal shunt,9 or pleurectomy (which is performed rarely for effusion control).


It is important to perform bronchoscopy when endobronchial lesions are suspected with accompanying symptoms of hemoptysis and atelectasis or, for large effusions, without contralateral mediastinal shift. Moreover, is it important to exclude endobronchial obstruction before attempting a pleurodesis when the entire lung remains collapsed after ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.