Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique

Pleural effusions constitute one of the most frequent pathologies encountered in hospitalized patients in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Most effusions are infectious in origin and require drainage with treatment of the underlying cause of the effusion. In 2010, 150 (50%) of the 302 thoracenteses performed in the pulmonary medicine ward revealed results consistent with Kaposi’s sarcoma (unpublished data). Previous studies have demonstrated that amongst malignant pleural effusions, lung cancer, metastatic breast cancer, lymphomas and Kaposi’s sarcoma are responsible for 75% of these effusions (1). The majority of these recur after simple thoracentesis within 5–10 days. Repeated thoracenteses in these cases are not recommended as this process can increase the risk of metastatic spread at the site of the puncture, pneumothorax, empyema, and loss of protein (2,3). The resulting protein depletion leads to a decrease in oncotic pressure and consequent new accumulation of fluid in the pleural space (2). In this situation, patients present with shortness of breath that interferes with their quality of life. Placement of a pleural drainage tube and thoracoscopy with installation of sclerosing agents in the pleural space is the preferred approach for these recurrent effusions (4-6). Indwelling catheters have not been found to be more effective than talc pleurodesis with chest tube drainage and in those with prolonged survival pleurodesis appears to be the most cost effective treatment (3,6)