Role of trans thoracic ultrasonography in pleurodesis for malignant pleural effusion

Background
Malignant pleural effusions (MEP) are common in cancer patients, often secondary to metastasis from lung or breast cancer.


Aim
To evaluate the role of transthoracic ultrasonography in guiding the pleurodesis pathway and assess its success.


Patients and methods
This observational case-control study was conducted on patients with MEP and indicated for pleurodesis admitted to the Chest Department of Kafr El-Sheikh University Hospital from January 2023 to 2024. This study included 45 patients. Five patients were excluded as they were diagnosed with an unexpandable lung after tube insertion. The remaining 40 patients were distributed in a 1: 1 ratio to receive either Transthoracic ultrasonography-guided care (in group A) or standard care (in group B).


Results

Time to chest tube removal (as the primary outcome) was significantly earlier in group A (1.6±0.5 vs. 3.3±0.85 in group B,
P
<0.001*). Both groups reported a baseline pleurodesis success in all cases with no significant difference between both groups at 1 and 3-month follow-up (success was achieved in 95% of patients in group A vs. 90% in group B at 1 month and 88.2% in group A vs. 80% in group B at 3 months). Group A reported shorter hospital stays with no significant difference in the lung sliding score among different follow-up measurements in group A. However, neither group showed significant differences in symptoms.



Conclusion
Using thoracic ultrasound to guide pleurodesis in patients with MPE is feasible and beneficial. It helps with the earlier removal of the chest tube and shorter duration of hospital stay. This does not compromise the efficacy of pleurodesis or worsen patient symptoms. A chest ultrasound can also detect the success of pleurodesis by using a sliding sign.