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Semin Respir Crit Care Med 2019; 40(03): 323-339
DOI: 10.1055/s-0039-1698285
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Malignant Pleural Effusions—What Is New

Rajesh Thomas
1   Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
2   Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, Australia
,
Bapti Roy
3   Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia
,
Fabien Maldonado
4   Department of Medicine, Vanderbilt University, Nashville, Tennessee
,
Y.C. Gary Lee
1   Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
2   Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, Australia
5   Department of Medicine, University of Hong Kong, Hong Kong
› Author Affiliations Funding R.T. has research fellowship funding support from the National Health and Medical Research Council and Cancer Council Western Australia and has received project funding from Sir Charles Gairdner Research Advisory Group. Y.C.G.L. is an Australian Medical Research Future Fund Practitioner Fellow and has received project funding from the National Health Medical Research Council, Cancer Australia, Cancer Council Western Australia, Sir Charles Gairdner Research Advisory Group, and the Dust Diseases Authority.
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Publication History

Publication Date:
16 September 2019 (online)

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Abstract

Malignant pleural effusion (MPE) is a common and challenging problem. Patients affected by MPE have a poor prognosis and suffer from breathlessness and impaired quality of life. The management of MPE has barely changed for many decades; however, recent research has driven new paradigms in the diagnosis and treatment of MPE and stimulated novel concepts that are being evaluated in many ongoing studies. This review provides an overview of recent advances in the diagnosis of MPE, including new cytopathology and imaging techniques, and the landmark studies that provide a solid evidence base to support the use of indwelling pleural catheters as first-line treatment in MPE. Lingering management dilemmas, including optimal chest drainage tube and role of surgery in MPE, and key knowledge gaps that are the focus of ongoing research are also highlighted.

Keywords

malignant pleural effusion - mesothelioma - thoracic ultrasound - pleural biopsy - indwelling pleural catheter - pleurodesis

Contributions

Guarantor: R.T. and Y.C.G.L.; Manuscript writing and final approval: all authors.