Purpose
To evaluate the role of US-guided small-bore chest catheters and US-based monitoring of fluid evacuation in rapid sclerotherapy of malignant pleural effusions
Material and methods
In 65 patients with recurrent malignant pleural effusions, a 9F catheter was inserted into the pleural space under US guidance. When US documented complete fluid evacuation, bleomycin (0.75 mg/kg) was injected via the tube. Fluid drainage was monitored for 12 hours; if fluid output was less than 100 mL, the pleural catheter was removed; otherwise, a second dose of bleomycin was administered after 24 hours. If loculations or fluid reaccumulations due to tube malfunctioning were detected, they were evacuated by US-guided thoracentesis, and bleomycin (1.5 mg/100 mL of fluid) was injected through the thoracentesis needle. All patients were monitored for fluid recurrence with thoracic US
Results
Thirty-eight patients received 1 dose of bleomycin, and 27 received 2 doses. In 13 patients with residual loculations, US-guided thoracentesis was performed, and bleomycin was injected into the loculations. In 36 patients, pleurodesis was completed within 24 hours; in 29, within 48 hours. 30-day response was 86%; long-term response was 63%. No complications nor serious side effects were observed
Conclusion
Rapid pleurodesis can be accomplished within 24 to 48 hours, with good short- and long-term responses. Thoracic US plays a pivotal role. It guides placement of the pleural catheter and is valuable in the monitoring of fluid evacuation for determining the right time for sclerosing agent administration and in the detection and treatment of loculations or residual pleural fluid due to tube malfunctioning