Pleural effusion: Malignancy

Malignant pleural effusions arise from neoplastic infiltration of the pleura, and are common manifestations of cancers which arise as a primary tumor of the pleura (mesothelioma) or secondary to primary cancers from other sites. Radiological investigations should always include a staging CT thorax and often will demonstrate pleural nodularity and involvement of the mediastinal border, which is highly suspicious of an underlying malignant process. The diagnosis of malignant pleural effusion is confirmed by the demonstration of neoplastic cells within the pleural fluid or pleural biopsy.

Malignant pleural effusions cause significant morbidity, with most experiencing shortness of breath. Management of a malignant pleural effusion is directed against treating the primary malignancy and relieving symptoms caused by the effusion. Removal of the pleural fluid usually will alleviate dyspnea, this can be initially be evaluated with a therapeutic aspiration. Onward management of recurrent pleural effusions includes the placement of an indwelling pleural catheter (IPC), or by drainage of the fluid via a chest drain or thoracoscopy and a talc pleurodesis.