Hemorrhagic Malignant Pleural Effusion: Diagnosis, Survival Rate, and Response to Talc Pleurodesis

Introduction: Hemorrhagic malignant pleural effusion (HMPE) is diagnosed in 47-50% of all malignant pleural effusions (MPE). Objectives: To evaluate clinical, radiological, and morphological manifestations of HMPE and results of talc pleurodesis treatment. Material and methods: Retrospective review of the medical charts of 135 MPE patients. HMPE group-42 patients, simple MPE group-63 patients; median age 67.9y, 43 males, 62 females. Results: Pronounced dyspnea (HMPE vs. simple MPE; 100% vs. 88.9%, P=0.024), chest pain (59.5% vs. 60.3%, P=1), general deterioration (78.6% vs. 74.6%, P=0.411) combined with large pleural effusion (81% vs. 50.8%, P=0.001) and thickening of parietal pleura (73.8% vs. 68.3%, P=0.349) were more specific for HMPE. Cytological examination of HMPE showed more malignant pleural fluid cells (81% vs. 63.5%, P=0.043). Histological examination revealed poorly differentiated types of tumors in 69.05% of HMPE (bronchogenic 33.33%, intestinal 16.67%, breast 14.3%) vs. 7.94% of simple MPE. Thoracoscopy in 19 HMPE patients showed bleeding nodules (94.7%) on thickened parietal pleura (84.2%), but none in simple MPE. Pleurodesis with talc by slurry (59%) and poudrage (41%) was less effective in HMPE patients after one month (failed response; 33.3% vs. 21.6, P=0.019), three months (42.9% vs. 25.7%, P=0.017), and six months (42.9% vs. 21.7%, P=0.035). Survival in HMPE was significantly lower (3.06 months vs. 5.37 months, P=0.0005). Conclusions: HMPE had more severe clinical-radiological manifestations due to poorly differentiated malignant process. Talc pleurodesis was less effective in HMPE and survival was poor.