Talc Particle Size: Does it Influence the Acute Systemic Inflammatory Response in Talc Pleurodesis?

REVIEW ARTICLE


Eduardo H. Genofre, Francisco S. Vargas and Evaldo Marchi

Affiliation: Laboratory of Pleura Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil


ABSTRACT

Talc has been the most used agent worldwide for induction of pleurodesis. However, despite its popularity, wide availability, low cost, and high success rate, there is great concern about the adverse effects of intrapleural talc application. Among these, we highlight acute respiratory failure that can be potentially fatal. The mechanism by which talc pleurodesis produces local and systemic inflammatory response is not well known. It is speculated that the large variation in particle size and the presence of contaminants in talc composition may be responsible for the effects observed in clinical practice. Experimental studies have shown that talc of smaller particles (<5 µm) may migrate to several organs. In addition, the intense local inflammation induced by talc may promote the loss of integrity of the capillary barrier, allowing the free flow of inflammatory mediators between the pleural and the systemic compartments. Despite the proven efficacy of talc in producing pleurodesis, its safety is not absolute.

Keywords: Pleura, pleural effusion, pleurodesis, magnesium silicates, inflammation, inflammation mediators, talc

Correspondence: Eduardo Henrique Genofre, MD, PhD; Av. Lins de Vasconcelos, 1455–Ap 141–Bl 01–CEP 01537-001–Sao Paulo–SP–Brazil. e-mail: ehgenofre@uol.com.br; ehgenofre@me.com