Diseases of the pleura: the use of talc for pleurodesis.

Talc either insufflated (poudrage) or in a suspension (slurry) is commonly used to create a pleurodesis in patients with recurrent pneumothorax or recurrent pleural effusions. There are now at least 32 cases in the literature in which patients developed the acute respiratory distress syndrome after receiving talc intrapleurally. The mechanism for the development of acute respiratory distress syndrome after the intrapleural administration of talc is not known, but it may be related to the systemic absorption of talc. Since there are effective alternatives to talc for producing pleurodesis (mechanical abrasion if thoracoscopy is performed; tetracycline derivatives or bleomycin if chest tubes are used), intrapleural talc should not be used to produce a pleurodesis.