This page covers management of clinically significant pleural effusion in patients with confirmed malignant pleural effusion (MPE) where the lung is expandable — specifically, where no non-expandable lung is known to be present.
The patient has confirmed malignant pleural effusion (MPE). A key feature of this scenario is that the lung is expandable — no non-expandable lung has been identified. This distinction directly shapes which interventions are appropriate for sustained fluid control.
In patients with confirmed MPE and expandable lung, management involves offering a choice between two procedural approaches aimed at controlling fluid accumulation and reducing the need for repeated interventions — an indwelling pleural catheter (IPC) or talc pleurodesis. The full clinical protocol, including the considerations that guide selection between these approaches and any additional options, is available below.
DOI: 10.1136/thorax-2023-220304
Patients without known non-expandable lung should be offered a choice of indwelling pleural catheter (IPC) or pleurodesis as first line intervention in the management of MPE.
Talc slurry or talc poudrage may be offered to patients with MPE to control fluid and reduce the need for repeated procedures.
Instillation of talc via an indwelling pleural catheter (IPC) should be offered to patients with expandable lung where the clinician or patient deems achieving pleurodesis and IPC removal to be important.
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