Obliteration of Pleural Space

Pleurodesis
Tetracycline usually used, no longer available

• Malignant effusion
  • pH <7.3 less than 50% success
  • pH > 7.3 - over 80% success
• Benign - chylothorax, lymphangiomyomatosis, CHF, pneumothorax
• Technique: tube thoracostomy in properly selected patient. When space drained or lung expanded, inject 250 mg lidocaine for anesthesia, reposition patient to get complete anesthesia, then inject doxycycline 5-10 mg/kg in 50 ml, flush tube with 50 ml saline, clamp tube for 2 hours, reposition patient to contact all pleural surfaces, unclamp tube, and return to suction

Other Methods

• Thoracoscopy with injection of sclerosing agents, thoracotomy, pleurectomy, pleuroperitoneal shunt, repeated thoracentesis, radiotherapy

Drug-Induced Pleural Disease

• Drug-induced lupus: procainamide, hydralazine, isoniazid, phenytoin, chlorpromazine, quinidine
• Others causing disease - dantrolene (eosinophilia), methysergide, procarbazine, methotrexate (thick fissures, no free fluid), bromocriptine, practolol (off market since 1976), amiodarone, mitomycin (effusions always with lung disease-steroid responsive), bleomycin, minoxidil (?)