Talc pleurodesis for recurrent pleural effusions: is cure worse than the actual insult?To the Editor: A 79-year-old Vietnamese male presented to our facility with shortness of breath Shortness of Breath Definition Shortness of breath, or dyspnea, is a feeling of difficult or labored breathing that is out of proportion to the patient's level of physical activity. . Past medical history was significant for hypertension, hypercholesterolemia and coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. . He had undergone coronary artery bypass grafting 3 months earlier, which had been complicated by recurrent exudative exudative of or pertaining to a process of exudation. exudative diathesis a disease of young pigs and chickens caused by a nutritional deficiency of vitamin E. Characterized by severe edema of the subcutaneous tissues. pleural effusions. His chest x-ray on this admission revealed a large, left-sided pleural effusion along with a small pneumothorax pneumothorax (n  mōthôr`ăks), collapse of a lung with escape of air into the pleural cavity between the lung and the chest wall. The cause may be traumatic (e.g. in the left upper lung zone. He
subsequently underwent thorascopic drainage and talc pleurodesis.
Eight hours after the procedure, he became hypotensive hypotensive /hy·po·ten·sive/ (-ten´siv) marked by low blood pressure or serving to reduce blood pressure. hy·po·ten·sive adj. 1. Of or characterized by low blood pressure. 2. (systolic blood pressure Systolic blood pressure Blood pressure when the heart contracts (beats). Mentioned in: Hypertension range: 70-80 mm Hg) and tachypneic (respiratory rate: 30-40/min) and mildly hypoxic (oxygen saturation on pulse oximetry: 94% on continuous oxygen via nonrebreather mask). The remainder of his vital signs and physical examination were unremarkable, although he did complain of mild chest pain on the left side. Repeat chest x-ray showed decreasing pleural effusions and no pulmonary infiltrates or edema. Twelve lead electrocardiograms, chemistry studies, complete blood count and 2 sets of cardiac enzymes (eight hours apart) all remained within normal limits. Subsequent echocardiography Echocardiography Definition Echocardiography is a diagnostic test that uses ultrasound waves to create an image of the heart muscle. Ultrasound waves that rebound or echo off the heart can show the size, shape, and movement of the heart's valves and , computed tomographic scanning and cortisol level were all unremarkable. Since he did not respond to 5 L of fluid administration, a systemic inflammatory response was suspected, and he was administered stress dose steroids to which he responded well. The offending cause was related to administration of talc, which was performed eight hours earlier. The recent availability of asbestos free talc has enhanced its superiority as an agent of choice for pleurodesis. However, its benefits nonetheless are garnished with adverse pulmonary effects. Complications ranging from mild pneumonitis to adult respiratory syndrome and respiratory failure have been cited multiple times. Although exact pathogenesis remains unclear, the proposed mechanism of injury is thought to be due to talc deposition in lung parenchyma Parenchyma A ground tissue of plants chiefly concerned with the manufacture and storage of food. The primary functions of plants, such as photosynthesis, assimilation, respiration, storage, secretion, and excretion—those associated with living with subsequent inflammation in various degrees of manifestation. (1) This theory has been substantiated by bronchoalveolar lavage findings. Interestingly, route of administration and dosage do not influence development of adverse reactions, whereas particle size may. (2) Misbah Baqir, MD Department of Internal Medicine St. Anthony's Central Hospital Denver, CO M. Haris U. Usman, MD Humaira N. Adenwalla, MD Department of Internal Medicine Mercy Catholic Medical Center Drexel University College of Medicine Drexel University College of Medicine is the medical school of Drexel University. It represents the consolidation of two venerable medical schools: the nation's first medical school for women and the first U.S. college of homeopathy. Residency Locations St. Darby, PA References 1. De Campos JR, Vargas FS, Werebe E, et al. Thoracoscopy talc poudrage: a 15 year experience. Chest 2001;119:801-806. 2. Montes JF, Ferrer J, Villarino MA, Baeza B, Crespo M, Garcia-Valero J. Influence of Talc Dose on Extrapleural Talc Dissemination after Talc Pleurodesis. Am J Respir Crit Care Med 2003 Aug 1; 168(3):348-55. |
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