Tuberc Respir Dis.  2007 Mar;62(3):217-222. 10.4046/trd.2007.62.3.217.

Two Cases of Fatal Hypoxemia after Talc Pleurodesis for Recurrent Malignant Pleural Effusion

• Park SA
• Lee HH
• Kim DJ
• Shim BY
• Song SH
• Kim CH
• Ahn MI
• Cho DG
• Cho KD
• Kim HK

• KMID: 1518467
• DOI: http://doi.org/10.4046/trd.2007.62.3.217

Abstract

Talc pleurodesis is a safe and effective treatment for a recurrent malignant pleural effusion. However, acute hypoxemia, pulmonary edema or acute respiratory failure can develop in a small number of patients. We report 2 patients who developed fatal hypoxemia after talc pleurodesis which was necessary the control recurrent pleural effusion. The first case was an 18-year old male diagnosed with Ewing's sarcoma with bilateral lung metastases and pleural effusion. The performance status was ECOG (Eastern Cooperative Foncology Group) grade 3. Fever along with hypoxemia and leukocytosis developed 10 hours after the second talc pleurodesis on the right side for an uncontrolled pleural effusion, The patient died from respiratory failure after 13 days. The second case was a 66-year old female diagnosed with non-small cell lung cancer with a bone metastasis. Two weeks after systemic chemotherapy, she complained of dyspnea, and a pleural effusion was observed on the right side. Her performance status was ECOG grade 3. Talc pleurodesis was performed for recurrent pleural effusion, but hypoxemia developed 6 days after pleurodesis and she died from respiratory failure 10 days after pleurodesis. In conclusion, talc pleurodesis should be performed very carefully in patients with a poor performance status, in cases with repeated pleurodesis, bilateral pleural effusion, recent chemotherapy, radiotherapy and when there are parenchymal metastatic lesions present.

Keyword

Pleural effusion; Talc; Pleurodesis; Hypoxemia

MeSH Terms

Adolescent
Aged
Anoxia*
Carcinoma, Non-Small-Cell Lung
Drug Therapy
Dyspnea
Female
Fever
Humans
Leukocytosis
Lung
Male
Neoplasm Metastasis
Pleural Effusion
Pleural Effusion, Malignant*
Pleurodesis*
Pulmonary Edema
Radiotherapy
Respiratory Insufficiency
Sarcoma, Ewing
Talc*
Talc

Figure

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  Figure 1 Chest PA shows moderate amount of right pleural effusion, left pleural thickening and left lung infiltration before right talc pleurodesis.

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  Figure 2 Chest PA shows increased amount of right pleural effusion, interstitial infiltrations and after talc pleurodesis.

• 

  Figure 3 Chest PA & right decubitus view show loculated right pleural effusion before pleurodesis.

• 

  Figure 4 Chest CT shows a 5.4×4.5 cm mass in the right lower lobe and surrounding atelectasis in right middle lobe. Large amount of right pleural effusion is noted before pleurodesis.

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  Figure 5 Chest PA shows multifocal patch consolidation and haziness in both lungs after talc pleurodesis.

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