Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Two Cases of Fatal Hypoxemia after Talc Pleurodesis for Recurrent Malignant Pleural Effusion

Talc 늑막유착술 이후 발생한 치명적 저산소증 2 예

  • Park, Shin Ae (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea) ;
  • Lee, Han Hee (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea) ;
  • Kim, Dae Jun (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea) ;
  • Shim, Byoung Yong (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea) ;
  • Song, So Hyang (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea) ;
  • Kim, Chi Hong (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea) ;
  • Ahn, Myeong Im (Lung Cancer center, Department of Radiology, College of Medicine, The Catholic University or Korea) ;
  • Cho, Deog Gon (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea) ;
  • Cho, Kyu Do (Lung Cancer center, Department of Thoracic Surgery, College of Medicine, The Catholic University or Korea) ;
  • Kim, Hoon-Kyo (Lung Cancer center, Department of Internal Medicine, College of Medicine, The Catholic University or Korea)
  • 박신애 (가톨릭대학교 의과대학 내과학교실) ;
  • 이한희 (가톨릭대학교 의과대학 내과학교실) ;
  • 김대준 (가톨릭대학교 의과대학 내과학교실) ;
  • 심병용 (가톨릭대학교 의과대학 내과학교실) ;
  • 송소향 (가톨릭대학교 의과대학 내과학교실) ;
  • 김치홍 (가톨릭대학교 의과대학 내과학교실) ;
  • 안명임 (가톨릭대학교 의과대학 방사선과학교실) ;
  • 조덕곤 (가톨릭대학교 의과대학 내과학교실) ;
  • 조규도 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 김훈교 (가톨릭대학교 의과대학 내과학교실)
  • Received : 2007.02.08
  • Accepted : 2007.02.27
  • Published : 2007.03.30
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Abstract

Talc pleurodesis is a safe and effective treatment for a recurrent malignant pleural effusion. However, acute hypoxemia, pulmonary edema or acute respiratory failure can develop in a small number of patients. We report 2 patients who developed fatal hypoxemia after talc pleurodesis which was necessary the control recurrent pleural effusion. The first case was an 18-year old male diagnosed with Ewing's sarcoma with bilateral lung metastases and pleural effusion. The performance status was ECOG (Eastern Cooperative Foncology Group) grade 3. Fever along with hypoxemia and leukocytosis developed 10 hours after the second talc pleurodesis on the right side for an uncontrolled pleural effusion, The patient died from respiratory failure after 13 days. The second case was a 66-year old female diagnosed with non-small cell lung cancer with a bone metastasis. Two weeks after systemic chemotherapy, she complained of dyspnea, and a pleural effusion was observed on the right side. Her performance status was ECOG grade 3. Talc pleurodesis was performed for recurrent pleural effusion, but hypoxemia developed 6 days after pleurodesis and she died from respiratory failure 10 days after pleurodesis. In conclusion, talc pleurodesis should be performed very carefully in patients with a poor performance status, in cases with repeated pleurodesis, bilateral pleural effusion, recent chemotherapy, radiotherapy and when there are parenchymal metastatic lesions present.

저자들은 악성흉수 환자에서 가장 많은 치료법으로 선택되고 있는 talc 늑막유착술 이후에 급성 저산소증으로 사망한 환자 2예를 경험하였다. Talc 늑막유착술은 안전하고 효과적인 치료이지만, talc를 5 g 이상 사용하거나, 전신상태가 불량하거나, 반복적인 늑막유착술을 시행한 경우나, 양측에 흉수가 있거나, 늑막유착술 전 2주 이내에 항암요법이나 방사선치료를 한 경우나 폐실질에 전이성병변이 있을 때 예후가 불량하므로 talc 늑막유착술 환자를 선정할 때 주의하여야 하겠다.

Keywords

References

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