Management strategies for recurrent pleural effusion: a clinical practice review

Recurrent pleural effusions can present a significant challenge for patients, causing respiratory symptoms and impairing quality of life. While serial thoracentesis can be a consideration, repeated need for procedures can add to increased healthcare utilization and cost. Patients also often express interest in a more durable intervention to limit the number of procedures they must undergo and to avoid the hassle of having to re-present to a healthcare facility. Definitive management strategies have therefore been investigated over the years to mitigate these problems. These can include placement of an indwelling pleural catheter (IPC) as well as chemical and surgical/thoracoscopic pleurodesis. Other therapies may also be considered depending on the underlying etiology of the effusion. Malignancy is a common etiology for recurrent pleural effusion and much of the data on these definitive interventions has come from this population. However, there has been increased interest in using similar strategies to manage non-malignant effusions as well. Ultimately, management of a recurrent pleural effusion requires careful patient/clinical evaluation along with a review of patient values, interests, and goals. A definitive approach should consider the underlying etiology, in particular whether it is malignant or non-malignant. This clinical practice review discusses the different strategies for definitive management of both malignant and non-malignant recurrent pleural effusions.