Pleurodesis: Definition, Procedure, and Indications

Pleurodesis is a procedure that is sometimes performed to relieve pleural effusions (build-up of fluid between the membranes surrounding the lungs) that recur due to lung cancer and other conditions. During the procedure, a chemical is placed between the two membranes that line the lungs, causing the membranes to scar and adhere together. This scarring obliterates the pleural space so that fluid can no longer accumulate in the space. Pleurodesis is done in the operating room with a general anesthetic.

The procedure is very effective in general, but may be less effective if several areas of effusion are present (loculated effusions). In these instances, other procedures, such as removing the pleura, may be needed. With advanced lung cancer, an alternative to pleurectomy is the placement of a catheter between the pleural cavity and the outside of the body to allow a person to remove the fluid that builds up at home. What else should you know about this procedure?

Overview

Pleurodesis is an intervention that's designed to get the two layers of the lung's lining (the pleura) to stick together. This obliterates the space between the layers (the pleural cavity) so that fluid (water, blood, or pus) can no longer build up between the layers.

The inner pleural lining is called the visceral pleura, and the outside pleural membrane is called the parietal pleura. Ordinarily, the equivalent of three to four teaspoons of lubricating fluid resides between the parietal and visceral pleural membranes.

A pleural effusion is excess fluid accumulation, and the pleural space can sometimes contain several extra liters of fluid.

Before pleurodesis is recommended, your doctor would consider whether pleural effusion (or pneumothorax) is likely to recur again in the future. If it is likely that the fluid accumulation is a one-time event, thoracentesis is often adequate for removing it. Unfortunately, benign pleural effusion (and pneumothoraces), and especially malignant pleural effusion often recur.

Procedure

During pleurodesis, a chemical is injected between the two pleural layers via a chest tube. The injection induces inflammation that leads to scarring. This scarring pulls and holds the two membranes together so that fluid or air can no longer collect in the space.

The procedure may be done through a small incision (video-assisted thoracoscopy or VATS) or via a chest tube.

There are two types of pleurodesis, which can be used together:

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

Indications

There are several situations in which pleurodesis is indicated, which result from medical conditions such as lung cancer, mesothelioma, cystic fibrosis, and other illnesses.

• Malignant pleural effusion – People with lung cancer, breast cancer, or metastases to the lung from other cancers may develop a malignant pleural effusion—which is a pleural effusion that contains cancer cells. When this is the case there are 2 options. One is a thoracentesis with placement of a stent to 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. 
• Benign recurrent pleural effusion
• Persistent pneumothorax - A pneumothorax is a collapsed lung. A pneumothorax can be treated with a chest tube. If the pneumothorax persists (a persistent air leak), or goes away and then recurs, further treatment (such as pleurodesis) to resolve the pneumothorax or prevent a recurrence is needed.
• Recurrent pneumothorax

Preparation

Before pleurodesis is considered, your physician will consider several things.

Most importantly, it’s important that removing the pleural fluid would be expected to improve your symptoms (such as decreased shortness of breath). In addition to this, some physicians recommend the procedure only if life expectancy is greater than one month.

On the other hand, spontaneous pneumothoraces may occur in people who are young and otherwise healthy. In this case, the procedure may be done to prevent another pneumothorax from occurring in the future.

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 pleura) will be needed. Another concern, for people who may have a lung transplant in the future, is that a history of pleurodesis can make the surgery more difficult.

For those who have pleural effusion due to minor conditions, or have recurrent pneumothoraces (often related to a hereditary factor), pleurodesis can help prevent recurrence of an effusion or pneumothorax.

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