Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Chemical pleurodesis

John E Heffner, MD
Section Editor
V Courtney Broaddus, MD
Deputy Editor
Geraldine Finlay, MD


Pleurodesis is a procedure that obliterates the pleural space to prevent recurrent pleural effusion or recurrent pneumothorax. It is most commonly performed by draining the effusion or intrapleural air and then inducing intrapleural inflammation and fibrosis by either instilling a chemical irritant or performing mechanical abrasion.

The use of a chemical irritant is known as chemical pleurodesis. Common questions about chemical pleurodesis include:

What are the indications?

What are the contraindications?

Which agent should be used?

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Apr 19, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc 2008; 83:235.
  2. Ghio AJ, Roggli V, Light RW. Talc should not be used for pleurodesis in patients with nonmalignant pleural effusions. Am J Respir Crit Care Med 2001; 164:1741; author reply 1741.
  3. Sudduth CD, Sahn SA. Pleurodesis for nonmalignant pleural effusions. Recommendations. Chest 1992; 102:1855.
  4. Glazer M, Berkman N, Lafair JS, Kramer MR. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion. Chest 2000; 117:1404.
  5. Freeman RK, Ascioti AJ, Dake M, Mahidhara RS. A propensity-matched comparison of pleurodesis or tunneled pleural catheter for heart failure patients with recurrent pleural effusion. Ann Thorac Surg 2014; 97:1872.
  6. Szeto CC, Chow KM. Pathogenesis and management of hydrothorax complicating peritoneal dialysis. Curr Opin Pulm Med 2004; 10:315.
  7. Maldonado F, Tazelaar HD, Wang CW, Ryu JH. Yellow nail syndrome: analysis of 41 consecutive patients. Chest 2008; 134:375.
  8. Vargas FS, Milanez JR, Filomeno LT, et al. Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. Chest 1994; 106:1771.
  9. Akin H, Olcmen A, Isgorucu O, et al. Approach to patients with chylothorax complicating pulmonary resection. Thorac Cardiovasc Surg 2012; 60:135.
  10. Breuer GS, Deeb M, Fisher D, Nesher G. Therapeutic options for refractory massive pleural effusion in systemic lupus erythematosus: a case study and review of the literature. Semin Arthritis Rheum 2005; 34:744.
  11. Bhatnagar R, Reid ED, Corcoran JP, et al. Indwelling pleural catheters for non-malignant effusions: a multicentre review of practice. Thorax 2014; 69:959.
  12. Patil M, Dhillon SS, Attwood K, et al. Management of Benign Pleural Effusions Using Indwelling Pleural Catheters: A Systematic Review and Meta-analysis. Chest 2017; 151:626.
  13. Majid A, Kheir F, Fashjian M, et al. Tunneled Pleural Catheter Placement with and without Talc Poudrage for Treatment of Pleural Effusions Due to Congestive Heart Failure. Ann Am Thorac Soc 2016; 13:212.
  14. Temes RT, Davis MS, Follis FM, et al. Videothoracoscopic treatment of hepatic hydrothorax. Ann Thorac Surg 1997; 64:1468.
  15. Hou F, Qi X, Guo X. Effectiveness and Safety of Pleurodesis for Hepatic Hydrothorax: A Systematic Review and Meta-Analysis. Dig Dis Sci 2016; 61:3321.
  16. Chen A, Massoni J, Jung D, Crippin J. Indwelling Tunneled Pleural Catheters for the Management of Hepatic Hydrothorax. A Pilot Study. Ann Am Thorac Soc 2016; 13:862.
  17. Györik S, Erni S, Studler U, et al. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J 2007; 29:757.
  18. Chen JS, Hsu HH, Huang PM, et al. Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial. Ann Surg 2012; 255:440.
  19. Chen JS, Chan WK, Tsai KT, et al. Simple aspiration and drainage and intrapleural minocycline pleurodesis versus simple aspiration and drainage for the initial treatment of primary spontaneous pneumothorax: an open-label, parallel-group, prospective, randomised, controlled trial. Lancet 2013; 381:1277.
  20. Sepehripour AH, Nasir A, Shah R. Does mechanical pleurodesis result in better outcomes than chemical pleurodesis for recurrent primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg 2012; 14:307.
  21. Doelken P. Clinical implications of unexpandable lung due to pleural disease. Am J Med Sci 2008; 335:21.
  22. Feller-Kopman D. Therapeutic thoracentesis: the role of ultrasound and pleural manometry. Curr Opin Pulm Med 2007; 13:312.
  23. Doelken P, Huggins JT, Pastis NJ, Sahn SA. Pleural manometry: technique and clinical implications. Chest 2004; 126:1764.
  24. Feller-Kopman D, Parker MJ, Schwartzstein RM. Assessment of pleural pressure in the evaluation of pleural effusions. Chest 2009; 135:201.
  25. Antunes G, Neville E. Management of malignant pleural effusions. Thorax 2000; 55:981.
  26. Sahn SA, Good JT Jr. Pleural fluid pH in malignant effusions. Diagnostic, prognostic, and therapeutic implications. Ann Intern Med 1988; 108:345.
  27. Martínez-Moragón E, Aparicio J, Sanchis J, et al. Malignant pleural effusion: prognostic factors for survival and response to chemical pleurodesis in a series of 120 cases. Respiration 1998; 65:108.
  28. Rodríguez-Panadero F, López Mejías J. Low glucose and pH levels in malignant pleural effusions. Diagnostic significance and prognostic value in respect to pleurodesis. Am Rev Respir Dis 1989; 139:663.
  29. Heffner JE, Nietert PJ, Barbieri C. Pleural fluid pH as a predictor of pleurodesis failure: analysis of primary data. Chest 2000; 117:87.
  30. Clive AO, Kahan BC, Hooper CE, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 2014; 69:1098.
  31. Verma A, Phua CK, Sim WY, et al. Pleural LDH as a prognostic marker in adenocarcinoma lung with malignant pleural effusion. Medicine (Baltimore) 2016; 95:e3996.
  32. Yoon DW, Cho JH, Choi YS, et al. Predictors of survival in patients who underwent video-assisted thoracic surgery talc pleurodesis for malignant pleural effusion. Thorac Cancer 2016; 7:393.
  33. Lin JB, Lai FC, Li X, et al. Sequential treatment strategy for malignant pleural effusion in non-small cell lung cancer with the activated epithelial grow factor receptor mutation. J Drug Target 2017; 25:119.
  34. Verma A, Chopra A, Lee YW, et al. Can EGFR-Tyrosine Kinase Inhibitors (TKI) Alone Without Talc Pleurodesis Prevent Recurrence of Malignant Pleural Effusion (MPE) in Lung Adenocarcinoma. Curr Drug Discov Technol 2016; 13:68.
  35. Tan C, Sedrakyan A, Browne J, et al. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006; 29:829.
  36. Yoshida K, Sugiura T, Takifuji N, et al. Randomized phase II trial of three intrapleural therapy regimens for the management of malignant pleural effusion in previously untreated non-small cell lung cancer: JCOG 9515. Lung Cancer 2007; 58:362.
  37. Balassoulis G, Sichletidis L, Spyratos D, et al. Efficacy and safety of erythromycin as sclerosing agent in patients with recurrent malignant pleural effusion. Am J Clin Oncol 2008; 31:384.
  38. Caglayan B, Torun E, Turan D, et al. Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large-bore chest tube. Ann Surg Oncol 2008; 15:2594.
  39. Salomaa ER, Pulkki K, Helenius H. Pleurodesis with doxycycline or Corynebacterium parvum in malignant pleural effusion. Acta Oncol 1995; 34:117.
  40. Terra RM, Kim SY, Pego-Fernandes PM, et al. Is silver nitrate pleurodesis for patients with malignant pleural effusion feasible and safe when performed in an outpatient setting? Ann Surg Oncol 2011; 18:1145.
  41. Clive AO, Jones HE, Bhatnagar R, et al. Interventions for the management of malignant pleural effusions: a network meta-analysis. Cochrane Database Syst Rev 2016; :CD010529.
  42. Diacon AH, Wyser C, Bolliger CT, et al. Prospective randomized comparison of thoracoscopic talc poudrage under local anesthesia versus bleomycin instillation for pleurodesis in malignant pleural effusions. Am J Respir Crit Care Med 2000; 162:1445.
  43. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004; :CD002916.
  44. Xia H, Wang XJ, Zhou Q, et al. Efficacy and safety of talc pleurodesis for malignant pleural effusion: a meta-analysis. PLoS One 2014; 9:e87060.
  45. Dresler CM, Olak J, Herndon JE 2nd, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 2005; 127:909.
  46. Almind M, Lange P, Viskum K. Spontaneous pneumothorax: comparison of simple drainage, talc pleurodesis, and tetracycline pleurodesis. Thorax 1989; 44:627.
  47. Heffner JE, Standerfer RJ, Torstveit J, Unruh L. Clinical efficacy of doxycycline for pleurodesis. Chest 1994; 105:1743.
  48. Paschoalini Mda S, Vargas FS, Marchi E, et al. Prospective randomized trial of silver nitrate vs talc slurry in pleurodesis for symptomatic malignant pleural effusions. Chest 2005; 128:684.
  49. Tabatabaei SA, Hashemi SM, Kamali A. Silver nitrate versus tetracycline in pleurodesis for malignant pleural effusions; a prospective randomized trial. Adv Biomed Res 2015; 4:178.
  50. Bucknor A, Harrison-Phipps K, Davies T, Toufektzian L. Is silver nitrate an effective means of pleurodesis? Interact Cardiovasc Thorac Surg 2015; 21:521.
  51. Agarwal R, Aggarwal AN, Gupta D. Efficacy and safety of iodopovidone pleurodesis through tube thoracostomy. Respirology 2006; 11:105.
  52. Olivares-Torres CA, Laniado-Laborín R, Chávez-García C, et al. Iodopovidone pleurodesis for recurrent pleural effusions. Chest 2002; 122:581.
  53. Ibrahim IM, Dokhan AL, El-Sessy AA, Eltaweel MF. Povidone-iodine pleurodesis versus talc pleurodesis in preventing recurrence of malignant pleural effusion. J Cardiothorac Surg 2015; 10:64.
  54. Andrade Neto JD, Terra RM, Teixeira RM, et al. Safety Profile of the Use of Iodopovidone for Pleurodesis in Patients with Malignant Pleural Effusion. Respiration 2015; 90:369.
  55. Kennedy L, Rusch VW, Strange C, et al. Pleurodesis using talc slurry. Chest 1994; 106:342.
  56. Xie C, Teixeira LR, McGovern JP, Light RW. Systemic corticosteroids decrease the effectiveness of talc pleurodesis. Am J Respir Crit Care Med 1998; 157:1441.
  57. Haddad FJ, Younes RN, Gross JL, Deheinzelin D. Pleurodesis in patients with malignant pleural effusions: talc slurry or bleomycin? Results of a prospective randomized trial. World J Surg 2004; 28:749.
  58. Rahman NM, Pepperell J, Rehal S, et al. Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube Size on Pain Control and Pleurodesis Efficacy Among Patients With Malignant Pleural Effusion: The TIME1 Randomized Clinical Trial. JAMA 2015; 314:2641.
  59. Maskell N, British Thoracic Society Pleural Disease Guideline Group. British Thoracic Society Pleural Disease Guidelines--2010 update. Thorax 2010; 65:667.
  60. Lee HJ, Feller-Kopman DJ. Rebuttal From Drs Lee and Feller-Kopman. Chest 2015; 148:13.
  61. Gillespie CT, DeCamp MM. Rebuttal From Drs Gillespie and DeCamp. Chest 2015; 148:14.
  62. Lee HJ, Feller-Kopman DJ. POINT: Should Small-Bore Pleural Catheter Placement Be the Preferred Initial Management for Malignant Pleural Effusions? Yes. Chest 2015; 148:9.
  63. Gillespie CT, DeCamp MM. COUNTERPOINT: Should Small-Bore Pleural Catheter Placement Be the Preferred Initial Management for Malignant Pleural Effusions? No. Chest 2015; 148:11.
  64. Villanueva AG, Gray AW Jr, Shahian DM, et al. Efficacy of short term versus long term tube thoracostomy drainage before tetracycline pleurodesis in the treatment of malignant pleural effusions. Thorax 1994; 49:23.
  65. Yildirim E, Dural K, Yazkan R, et al. Rapid pleurodesis in symptomatic malignant pleural effusion. Eur J Cardiothorac Surg 2005; 27:19.
  66. Spiegler PA, Hurewitz AN, Groth ML. Rapid pleurodesis for malignant pleural effusions. Chest 2003; 123:1895.
  67. Ahmed L, Ip H, Rao D, et al. Talc pleurodesis through indwelling pleural catheters for malignant pleural effusions: retrospective case series of a novel clinical pathway. Chest 2014; 146:e190.
  68. Antunes G, Neville E, Duffy J, et al. BTS guidelines for the management of malignant pleural effusions. Thorax 2003; 58 Suppl 2:ii29.
  69. Putnam JB Jr, Light RW, Rodriguez RM, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer 1999; 86:1992.
  70. Porcel JM, Salud A, Nabal M, et al. Rapid pleurodesis with doxycycline through a small-bore catheter for the treatment of metastatic malignant effusions. Support Care Cancer 2006; 14:475.
  71. Sherman S, Ravikrishnan KP, Patel AS, Seidman JC. Optimum anesthesia with intrapleural lidocaine during chemical pleurodesis with tetracycline. Chest 1988; 93:533.
  72. DiBardino DJ, Vanatta JM, Fagan SP, Awad SS. Acute respiratory failure after pleurodesis with doxycycline. Ann Thorac Surg 2002; 74:257.
  73. Lorch DG, Gordon L, Wooten S, et al. Effect of patient positioning on distribution of tetracycline in the pleural space during pleurodesis. Chest 1988; 93:527.
  74. Dryzer SR, Allen ML, Strange C, Sahn SA. A comparison of rotation and nonrotation in tetracycline pleurodesis. Chest 1993; 104:1763.
  75. Goodman A, Davies CW. Efficacy of short-term versus long-term chest tube drainage following talc slurry pleurodesis in patients with malignant pleural effusions: a randomised trial. Lung Cancer 2006; 54:51.
  76. Maskell NA, Lee YC, Gleeson FV, et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med 2004; 170:377.
  77. Froudarakis ME, Klimathianaki M, Pougounias M. Systemic inflammatory reaction after thoracoscopic talc poudrage. Chest 2006; 129:356.
  78. Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest 1994; 106:1215.
  79. Abraham G, Cherian JH, Gopalakrishnan TJ. Pyopneumothorax with bronchofleural fistula following tetracycline pleurodesis in a patient on CAPD. Perit Dial Int 1992; 12:327.
  80. de Campos JR, Vargas FS, de Campos Werebe E, et al. Thoracoscopy talc poudrage : a 15-year experience. Chest 2001; 119:801.
  81. Campos JR, Werebe EC, Vargas FS, et al. Respiratory failure due to insufflated talc. Lancet 1997; 349:251.
  82. Kennedy L, Harley RA, Sahn SA, Strange C. Talc slurry pleurodesis. Pleural fluid and histologic analysis. Chest 1995; 107:1707.
  83. Montes JF, Ferrer J, Villarino MA, et al. Influence of talc dose on extrapleural talc dissemination after talc pleurodesis. Am J Respir Crit Care Med 2003; 168:348.
  84. Kleinfeld M, Messite J, Kooyman O, Zaki MH. Mortality among talc miners and millers in New York State. Arch Environ Health 1967; 14:663.
  85. Lange P, Mortensen J, Groth S. Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage. Thorax 1988; 43:559.
  86. A survey of the long-term effects of talc and kaolin pleurodesis. Research Committee of the British Thoracic Association and the Medical Research Council Pneumoconiosis Unit. Br J Dis Chest 1979; 73:285.