The management of recurrent pleural effusion.

Recurrent pleura! effusions occur in a large number of patients with benign and malignant disease. In most cases an accurate diagnosis of thè underlying disease can be established by a combination of pleura! fluid study, cytology, pleura! biopsy and thoracoscopy. The most common causes of malignant pleura! effusion are carcinoma of thè lung, metastatic cancer and breast carcinoma. In patients with unresectable tumors or disseminated cancer, successful suppression of thè reaccumulation of fluid in thè pleura! space, can relieve thè respiratory discomfort and then improve their quality of lite. Different techniques have been used to prevent recurrence of pleura! effusion. Systemic therapies are of little help, while loca! instillation of severa! therapeutic agents, when used in addition to thoracostomy drainage, produces good or excellent results. Tetracycline or Tale seem to be superior to other agents and, because of their low cosi, availability and minima! toxicity, are considered thè treatments of choice. Beta interferon is a promising agent bui thè experience is too limited to draw definitive conclusions. Pleurectomy in rare selected cases can be considered a satisfactory form of therapy.