Surgical pleural biopsy, talc and drains at home
Thoracic surgeons can help with diagnosis and treat the symptoms of problems with the lining of the lung (the pleura). This may be thickening of the pleura or a collection of fluid in the pleural space (called a pleural effusion). These may occur together. Thickened pleura and fluid in the pleural space compress the lung, this can make you feel very breathless, generally unwell or have chest pain.
With surgery we can drain fluid, take samples for diagnosis and provide a way to control fluid buildup. The 2 main ways of controlling fluid buildup are talc and a thin flexible drain that is kept in place when you go home. Keyhole surgery is normally done for these 2 methods.
Causes of pleural abnormalities include:
The lining of the lung can become irritated, thickened and make fluid. Asbestos or certain types of dusts at work may cause irritation. Some medical conditions can also cause irritation, such as rheumatoid arthritis.
- Previous severe chest infection
Severe chest infections can cause infected fluid to build up around the lung. If the body fights off the infection scar tissue and fluid may remain. Tuberculosis (TB) infection can cause the fluid or thickening.
- Previous bleeding in the chest
For example, after breaking ribs in an accident there may be a small amount of bleeding that heals on its own but leaves fluid or thickening behind.
Mesothelioma is a cancer that starts in the pleura. It is much more common in people who have worked with asbestos but can occur in people who don’t remember being around asbestos. Lung cancer or spread of cancer from elsewhere in the body can cause a pleural effusion.
- Heart problems
If the heart is not pumping properly fluid can build up but this is diagnosed and treated without the need for any surgery.
Sometimes it is impossible to get a biopsy using the keyhole method. In this case we make one of the keyhole incisions bigger to get a biopsy.
During surgery sterile talc powder is sprayed inside the chest to evenly coat the pleura.
After draining the fluid during surgery the lung may still be compressed by thickened pleura. This leaves a space between the 2 layers of pleura; talc will not work in this case. Fluid would build up again. The IPC allows the fluid to be drained intermittently and relieve the breathlessness. You (and a close friend/relative) can be trained how to drain fluid from the IPC at home. You will learn how to do this before you go home after surgery. Support from your district nurse will be arranged too. An IPC allows you to control your breathlessness, you may feel that it is time to drain the fluid off by your breathing. Drainage is usually needed every other day.
In addition the following risks apply:
- Not getting a diagnosis from the biopsies
- Build up of fluid again despite surgery
- Damage to organs in the abdomen
It normally takes approximately 2 weeks for the laboratory to test the samples. Testing for TB may take 6 weeks. If we receive results before you are due to come to a clinic appointment for follow up we may call you.
Having a diagnosis can guide which treatments would be best for you. It can also give you an idea of what to expect from the disease, including symptoms or whether the disease may shorten your life.
If you do not want to have an operation to get a diagnosis other options may include:
- Relying on existing tests (such as scans) to judge which disease is most likely
- Repeating a previous test
- Continuing close observation
If you do not want an operation to improve your symptoms other options may include:
- Palliative care
- We can use talc via chest drain in certain cases. This means you would still need a chest drain but can be done with you awake. Sterile talc powder is mixed with sterile water and flushed up the chest drain instead of being sprayed over the pleura. Surgical talc has a higher success rate than talc via a drain. Talc via a drain may be more painful that talc via surgery.
- Samples may be taken and a pleural catheter may be inserted using local anaesthetic instead of a general anaesthetic in some cases.
It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.