Talc pleurodesis for the treatment of pneumothorax and pleural effusion.

Early interest in the development of pleural symphysis resulted from the desire of surgeons to produce adhesions to facilitate lobectomy.1 Various agents were tried but were found to be of limited value. The indications for pleurodesis have expanded over the years to include the treatment of benign and malignant effusions, the prevention of recurrence of pneumothoraces, and, more recently, to assist in the closure of persistent bronchopleural fistulas. Over the past 20 years, the favorable safety profile, low cost, availability, and ease of administration led to widespread use of tetracycline as the first-line pleurodesis agent. However, parenteral tetracycline is no longer available in the United States. As an effective, inexpensive, and safe pleurodesis agent for use at the bedside is needed, there has been renewed interest in bleomycin and talc as well as new investigation of tetracycline-like agents, such as minocycline2-4 and doxycycline.5'6 Because of its excellent record of successful pleurodesis7-9 and low cost, talc has received substantial attention recently. The purpose of this article is to review the chemical properties, efficacy, and safety of talc as a pleurodesis agent.