Malignant Pleural Effusions and Mesothelioma

Pleural effusions are a common problem in the palliative phase of a number of different conditions and usually indicate advanced or metastatic disease. They are associated with a significant symptom burden. The investigation of a unilateral pleural effusion starts with ultrasound-guided pleural aspiration, followed if necessary by thoracoscopy or CT-guided biopsy. The recurrent symptomatic effusion can be drained, but without pleurodesis is likely to recur. The options for pleurodesis and the role of indwelling pleural catheters are discussed. The chapter then describes the epidemiology and presenting features of malignant pleural mesothelioma. Management strategies include preventing recurrence of the effusion, symptom control with drugs, and consideration of the appropriateness of chemotherapy. There is rarely a place for surgery. As mesothelioma is ultimately fatal, there is discussion of management in advanced disease and in particular of peritoneal mesothelioma. Medicolegal aspects are also considered.