Synergistic Sealing of the Pleural Space: Combining Thoracoscopic Talc Poudrage and IPC for Malignant Pleural...

Management of malignant pleural effusion (MPE) via medical thoracoscopy presents a clinical challenge, particularly when deciding whether to proceed with talc poudrage during the same setting. This decision is often complicated by uncertainty about lung re-expansion and the potential failure of pleurodesis. We describe a series of three patients with cancer-associated MPE who underwent medical thoracoscopy with talc poudrage combined with indwelling pleural catheter (IPC) insertion. This combined approach served as a practical and effective strategy, offering immediate symptom relief, facilitating early pleural symphysis when feasible, and providing a reliable fallback option in cases of non-expanding lung. The dual-modality technique highlights a safe, flexible pathway for managing MPE with improved procedural confidence and patient-centred outcomes. We report 3 cases of MPE successfully achieving pleurodesis with a combination of talc poudrage and IPC, resulting in removal of IPC on follow-up.