|Year : 2022 | Volume
| Issue : 2 | Page : 49
Recurrent pleural effusions: A vexing problem
R Narasimhan1, N Ajay Narasimhan2, Aarthi Narasimhan3
1 Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
2 Department of Thoracic Surgery, Madras Medical College, Chennai, Tamil Nadu, India
3 Consultant Pulmonologist, Respiratory Research Foundation of India, Chennai, Tamil Nadu, India
|Date of Submission||15-Nov-2022|
|Date of Acceptance||16-Nov-2022|
|Date of Web Publication||23-Dec-2022|
Dr. R Narasimhan
Department of Respiratory Medicine, Apollo Main Hospital, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Narasimhan R, Narasimhan N A, Narasimhan A. Recurrent pleural effusions: A vexing problem. J Assoc Pulmonologist Tamilnadu 2022;5:49
|How to cite this URL:|
Narasimhan R, Narasimhan N A, Narasimhan A. Recurrent pleural effusions: A vexing problem. J Assoc Pulmonologist Tamilnadu [serial online] 2022 [cited 2023 Jan 27];5:49. Available from: http://www.japt.com/text.asp?2022/5/2/49/365085
Pleural effusions are a common cause for pulmonary consultations across the world. They can be broadly classified into transudates and exudates. I belong to an era where all pleural effusions are considered tuberculous unless proved otherwise. Majority of the pleural effusions used to resolve with antituberculosis treatment. Transudative effusions are considered easy to treat as the common advice was to treat the primary cause.
It never used to be as simple as that because some pleural effusions would not resolve that easily. Examples are massive pleural effusions due to chronic liver disease that turn out to be transudates but cause a lot of respiratory embarrassment. Malignant pleural effusions are exudative effusions that accumulate very fast and cause respiratory problems. In transudative effusions, multiple therapeutic effusions are not the answer as that results in severe hypoproteinemia and also pain due to multiple pokes in the chest wall. Same is the case with malignant pleural effusions that accumulate very fast and multiple therapeutic aspirations are not the answer. Lymphomas, breast cancers, and lung cancers top the list in malignant pleural effusions. Although they indicate that they are stage 4 malignancies, it is imperative on the part of the pulmonologist to give a good quality of life.
PleurX catheters were used in the management of nonmalignant pleural effusions with good success. The mechanism of action was to induce a pleurodesis by a mechanical means. It was found that the time to pleurodesis was short in hepatic hydrothorax compared to congestive heart failure. Indwelling pleural catheters have been used for a decade in malignant pleural effusions. This is suggested in patients where life expectancy was short and surgical decortication is not possible. Pleurodesis is another option, but this needs complete aspiration of pleural effusion to dryness which is hard to achieve. If pleurodesis is attempted in such cases, multiple loculations make the intrapleural catheters a futile exercise. There are also occasions where the ling is trapped to endobronchial occlusion with massive pleural effusions where pleurodesis is impossible as one of the main principles on which pleurodesis rest is a complete expansion of the lung. Similar situations occur in malignant pleural effusions. In these cases, indwelling catheters are an answer to give them a good quality of life although not curative from causative angle.
In this issue, we have highlighted the role of indwelling pleural catheters in malignant recurrent pleural effusions. The original article highlights the indications and problems. As a pulmonologist, this procedure should be suggested early even before attempting chemical pleurodesis as the quality of life is better and the patient himself can drain the effusion at home in a homely atmosphere. At last, good solutions have been discovered for a vexing problem of recurrent massive pleural effusions and it is only time that all pulmonologists get well versed with this safe outpatient and daycare procedure.