Malignant pleural effusions

Pleural effusions are a significant public health problem. Diagnosis of over I million pleural effusions is estimated to occur yearly in the United States. Patients with pleural effusions are frequently symptomatic with dyspnea and loss of function. Treatment goals for these patients should focus on relief or elimination of dyspnea, restoration of normal activity and function, minimization or elimination of hospitalization, and efficient use of medical care resources [1,2]. Medical management, with treatment of the underlying cause, may be effective in some transudates. For exudates, management may be more difficult. Malignant pleural effusions (MPE; those effusions associated with primary, concurrent, or distant neoplasms) may be more complex, with frequent recurrence. The arbitrary view of requiring pleural symphysis, achieved by in-hospital drainage, with pleurodesis achieved by sclerosis with chemical or other agents, may subject the patient to a prolonged hospitalization or to other interventions that may significantly reduce quality of life and remaining survival outside the hospital.