Sonographically guided small-bore chest tubes and sonographic monitoring for rapid sclerotherapy of recurrent malignant pleural effusions.
OBJECTIVE
To evaluate the role of sonographically guided small-bore chest catheters and sonographically based monitoring of fluid evacuation in rapid sclerotherapy of malignant pleural effusions.


METHODS
In 50 patients with recurrent malignant pleural effusions, a 9F catheter was inserted into the pleural space under sonographic guidance. When sonography documented complete fluid evacuation, bleomycin (0.75 mg/kg) was injected via the tube. Fluid drainage was monitored for 12 hours; if fluid output was less than 100 mL, the pleural catheter was removed; otherwise, a second dose of bleomycin was administered after 24 hours. If loculations or fluid reaccumulations due to tube malfunctioning were detected, they were evacuated by sonographically guided thoracentesis, and bleomycin (1.5 mg/100 mL of fluid) was injected through the thoracentesis needle. All patients were monitored for fluid recurrence with thoracic sonography.


RESULTS
Twenty-nine patients received 1 dose of bleomycin, and 21 received 2 doses. In 11 patients with residual loculations, sonographically guided thoracentesis was performed, and bleomycin was injected into the loculations. In 29 patients, pleurodesis was completed within 24 hours; in 21, it was completed within 48 hours. The 30-day response was 84%; the long-term response was 60%. No complications or serious side effects were observed.


CONCLUSIONS
Rapid pleurodesis can be accomplished within 24 to 48 hours, with good short- and long-term responses. Thoracic sonography plays a pivotal role. It guides placement of the pleural catheter and is valuable in the monitoring of fluid evacuation for determining the right time for sclerosing agent administration and in the detection and treatment of loculations or residual pleural fluid due to tube malfunctioning.
Section of Interventional Ultrasound, Department of Internal Medicine, St Anna Hospital, Corso Giovecca 203, I-44100 Ferrara, Italy. srs@unife.it
Sergio
S
Sartori
Paola
P
Tombesi
Davide
D
Tassinari
Piercarlo
P
Ceccotti
Ingrid
I
Nielsen
Lucio
L
Trevisani
Vincenzo
V
Abbasciano
D000328:Adult; D000368:Aged; D015505:Chest Tubes; D004322:Drainage; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000628:therapy*; D009378:Neoplasms, Multiple Primary; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging* / Q000628:therapy*; D018700:Pleurodesis; D011446:Prospective Studies; D015911:Sclerotherapy; D014463:Ultrasonography