ABSTRACT
Pathophysiology 279 Mechanism of pleural metastasis 279 Para-malignant effusions 280 Pleural localization and propagation
of malignant disease 280 Molecular mechanisms280
Clinical presentation280 Radiographic appearance 280
Chest radiograph 280 Thoracic ultrasound281
Computed tomography 282 Positron emission tomography 282 Magnetic resonance imaging 282
Diagnosis of malignant pleural effusions282 Thoracentesis 282 Immunohistochemistry 283 Cytogenetics 283 Closed pleural biopsy 283 Image-guided closed pleural biopsy 283
Medical thoracoscopy 283 Surgical pleural biopsy 284 Tumor markers284
Management of malignant pleural effusions 284 General principles284 Therapeutic thoracentesis 284 Pleurodesis 285 Therapeutic options after failed pleurodesis 285 Indwelling pleural catheter 285 Surgery 285 Pleuro-peritoneal shunt 286
Management of MPE: Specific considerations 287 Malignant pleural effusion in lung cancer 287 Visceral pleural invasion 288 Pleural lavage cytology 288 MPE and lung cancer with molecular mutations288 Pleural effusion in malignant pleural
mesothelioma 289 Pleural effusion in lympho-proliferative diseases 289
Future directions 289 References 291
Malignant pleural eusion (MPE) is a common clinical problem, aecting 150,000 patients in the United States each year.1 Postmortem examination of patients who died from cancers showed that MPE occurred in 15% of cases.2 MPE accounts for ~22% of all pleural eusions (and 42% of exudates) in epidemiologic studies.3 In developed countries, MPE is one of the top three causes of a pleural eusion, along with heart failure and para-pneumonic eusions.1
