Management of malignant pleural effusion: Options and recommended approaches

There is no consensus on the best management of symptomatic malignant pleural effusion. Drainage with a small bore pleural catheter is preferred over a wide bore catheter or recurrent pleural aspiration in patients with symptomatic malignant pleural effusion, for equivalent efficacy and patient comfort. If resources allow, chemical pleurodesis under thoracoscopy, with talc as sclerosant, is preferred for fully expanded lung over bedside chemical pleurodesis in fit patients. A chronic indwelling catheter is an alternative. Controversy exists over the use of chemical pleurodesis or a long term indwelling catheter as the first line management of choice of malignant pleural effusion. Pleural effusion in the entrapped lung scenario is a problematic situation. Pleuroperitoneal shunting or decortication procedures are out of favor as they are more invasive and present more complications. Management algorithm is recommended based on the current data.