대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 391 Date 2005-04-23

  • Courtesy of Yookyung Kim, M.D. / Ewha Womans University Hospital, Seoul, Korea
  • Age/Sex 30 / F
  • Chief ComplaintDyspnea after pleurodesis with talc and bleomycin. Known breast carcinoma with lung and pleural metastasis
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
ARDS after pleurodesis with talc
Radiologic Findings
Initial chest radiograph shows left hydropneumothorax with chest tube insertion. Also noted are a large mass in right lower lung zone and small right pleural effusion. On follow up chest radiograph obtained 2 days after pleurodesis with talc and bleomycin, newly appeared consolidation is seen in the left lung. Chest CT scans obtained 8 days after the pleurodesis show diffuse consolidation and ground-glass attenuation in entire left lung and patchy ground-glass attenuation in right upper lobe. Also noted is right pleural effusion.
Brief Review
Talc is the most commonly used agent for chemical pleurodesis, even though its minor and major cardiovascular and pulmonary complications. Post-talc ARDS is a severe form of acute, sometimes lethal, lung jnjury occurring shortly after intrapleural administration of talc in up to 9% of patients. Over 30 reported cases of acute respiratory distress syndrome after intrapleural talc administration, 9 of these have been fatal. It is hypothesized that the mechanism for talc pleurodesis-induced hypoxemia may be the escape of very small talc particles from the pleural space through the parietal pleural pores. This escape results in the systemic talc dissemination followed by systemic and lung inflammation.

The extrapleural talc dissemination is a phenomenon dependent on both particle size and the talc dose used. In a study, talc pleurodesis with a mean particle size of less than 15 μm ("mixed" talc) produces more lung and systemic inflammation than tetracycline or "graded" talc (most particles < 10 μm were removed). In other experimental study, rabbits receiving a high dose had talc in the ipsilateral (70%) and contralateral (55%) lung, mediastinum (90%), pericardium (30%), and liver (25%).
References
1. JF Montes, J Ferrer, MA Villarino et al. Influence of talc dose on extrapleural talc dissemination after talc pleurodesis. Am J Respir Crit Care Med. 2003 Aug 1;168(3):348-55

2. NA Maskell, YCG Lee, FV Gleeson et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004 Aug 15;170(4):377-82
Keywords
Lung, Non-infectious inflammation,

No. of Applicants : 29

▶ Correct Answer : 6/29,  20.7%
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - LIJ, NY Pinar Karakas
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Yonsei University Hospital, Korea Eun Hye Yoo
▶ Semi-Correct Answer : 21/29,  72.4%
  • - Annecy Hospital, FRANCE Gilles Gennin
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier Philippe
  • - ASL BOLOGNA Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - CHU Besancon, France Sebastien Aubry
  • - CIM Saint Dizier, France JC Leclerc
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Gwangmyoung Sungae Hospital, Korea Jiyong Rhee
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Jikei University of Medicine , Japan Shigeki Misumi
  • - Jinju Jeil Hospital, Korea Hyung-Gon Lee
  • - Kyunghee University Hospital, Seoul, Korea Su Youn Sim
  • - OBP, Russia Lepikhina Dasha
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - Royal Melbourne Hospital, Melbourne, Australia Stefan Heinze
  • - Samsung Medical Center, Seoul, Korea Ha Young Kim
  • - Seoul National University Hospital, Korea Dae Sik Kim
  • - Yonsei University Hospital, Korea Hye-Jeong Lee
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