Talc pleurodesis : a controversial issue.

The use of talc for pleurodesis is a controversial issue. I have used talc in patients with malignant pleural effusion, recurrent pneumothorax, chylothorax and in selected cases of empyema. During pleuroscopy talc is insufflated through the lumen of the mediastinoscope. Up to 2 gr of purified talc is sprinkled under vision over the entire pleural surface. Of our total experience with 83 patients, 77 were available for follow up. Among 52 patients with pleural effusion, complete pleurodesis was achieved in 43 and partial pleurodesis in 5, with 4 failures. Of 21 patients with recurrent pneumothorax, complete pleural symphysis was achieved in 17 and partial in 3, with 1 failure. In all patients with empyema and with chylothorax, pleurodesis was complete. In total, obliteration of the pleural space was complete (excellent result) in 64 patients (83%) and partial (fair result) in 8 patients (10.5%). Talc failed to induced pleural symphysis only in 5 patients (6.5%). There were no complications and no deaths related to the procedure. This is attributed to the fact that only purified (British Pharmacopoeia) talc was used and its amount never exceeded 2 gr. The use of talc in pleura is safe and useful. It provides excellent palliation in patients with malignant pleural effusion and cure in the other groups. Excessive concern about complications of using talc is unjustified.