CT appearances of talc pleurodesis

Our plain-English summary of CT appearances of talc pleurodesis, by S. Narayanaswamy, S. Kamath, M. Williams (Clinical Radiology, 2007).

The study

• Authors: S. Narayanaswamy, S. Kamath, M. Williams
• Journal: Clinical Radiology
• Published: 2007;62(3):233-7
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: To report the computed tomography (CT) appearances of talc pleurodesis in the management of patients with pleural effusions and spontaneous pneumothorax.

Materials And Methods: The post-pleurodesis CT studies of 16 patients obtained over a 5-year period were reviewed. The mean age was 63 years (range 41-79 years). Ten patients were male. After pleurodesis, nine patients underwent a single chest CT examination and seven patients underwent more than one.

Results: The characteristic finding observed in all patients, except one, was the presence of high-density deposits in the posterior basal regions of the pleural space. These were typically linear in seven patients, nodular in two, and a combination of linear and nodular in six. In five patients talc deposits were present on both the visceral and parietal pleura separated by an effusion (a variant of the split pleura sign). Talc deposits extended into an interlobar fissure with associated fissural thickening in five patients. In patients who underwent more than one CT study, the appearances remained stable.

Conclusions: The typical finding was the presence of high attenuation areas in the posterior basal regions of the pleural space. Two new appearances were observed: extension of talc deposits into the fissure and the presence of a variant of the split pleura sign. It is important to recognize these CT appearances so as not to confuse them with other conditions such as asbestos exposure.

In plain English

This was a retrospective review of chest CT scans of 16 patients at Derriford Hospital in Plymouth, UK, who had undergone talc pleurodesis, a procedure that places talc in the chest to close off the pleural space. The scans dated from January 2001 to December 2005. The patients' underlying conditions were mesothelioma (7 patients), spontaneous pneumothorax (4), metastatic adenocarcinoma (2), lung carcinoma (2) and lymphoma (1). In all patients except one, dense talc deposits were seen on the pleural surface, mainly in the lower back part of the chest. The deposits were linear in seven patients, nodular in two and both in six. Five patients had talc on both pleural layers separated by fluid, a variant of the split pleura sign. Five had talc extending into a lung fissure. The deposits did not change in the seven patients scanned more than once. In one patient, scattered nodular deposits mimicked previous asbestos exposure. The authors concluded that these appearances should be recognized so they are not confused with other conditions such as asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of CT images (case series) of patients who had talc pleurodesis
• Who was studied: 16 patients (mean age 63, range 41 to 79; ten male) who had talc pleurodesis and a later chest CT, identified from surgical records of 200 patients coded for pleurodesis at Derriford Hospital, Plymouth, UK. Images were from January 2001 to December 2005. Underlying conditions: mesothelioma (n = 7), spontaneous pneumothorax (n = 4), metastatic adenocarcinoma (n = 2), lung carcinoma (n = 2), lymphoma (n = 1).
• Exposure: Talc pleurodesis. Talc was introduced by video-assisted thoracoscopic surgery in 12 patients and by chest drain in 4. The study did not examine asbestos exposure.
• Main results:
  • In all patients except one, high-density deposits were present in the posterior basal regions of the pleural space.
  • The deposits were linear in seven patients, nodular in two, and a combination of linear and nodular in six.
  • The deposits extended up to the apex of the chest in two cases.
  • A variant of the split pleura sign (talc on both visceral and parietal pleura separated by an effusion) was present in five patients.
  • Talc deposits extended into a fissure, with fissural thickening, in five patients.
  • In the seven patients with more than one chest CT, the talc deposits did not change.
  • In one patient, multiple scattered nodular high-attenuation areas mimicked previous asbestos exposure.
  • No CT evidence of talc deposits in the lung tissue itself was found.
• The authors' conclusion: The authors concluded that the typical finding was high-attenuation areas in the posterior basal pleural space. They reported two new appearances: talc extending into the fissure and a variant of the split pleura sign. They stated that these CT appearances should be recognized so they are not confused with other conditions such as asbestos exposure.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc Pleurodesis, Pleural Effusion, Pneumothorax, Pleurodesis, Talc, Parietal Pleura, Pleura, Asbestos Exposure.

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• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)

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