The radiologic appearance of chemical pleurodesis.

Intrapleural instillation of drugs (chemical pleurodesis) was performed in 57 patients with malignant pleural effusions or recurrent pneumothorax. Agents used included mechlorethamine hydrochloride (nitrogen mustard), quinacrine hydrochloride (Atabrine), tetracycline, and others. The most frequent finding on chest radiographs (56%) was multiple loculated air-fluid levels, an appearance simulating an empyema. Resolution of these changes occurred in one to three weeks. Late sequelae included pleural thickening (63%) or the development of a severe fibrothorax. In the majority of the six patients treated for recurrent pneumothoraces, the radiographic appearance returned to normal. The appearance of a new air-fluid level following withdrawal of the chest tube in one patient indicated a complicating empyema.