Medical Thoracoscopy-Guided Talc Pleurodesis in a Pediatric Patient with Malignant Pleural Effusion

Abstract

Background: Pleurodesis is rarely performed in pediatric patients due to limited indications and lack of supporting evidence. However, in cases of malignant pleural effusion, it may serve as a palliative intervention to prevent fluid recurrence.
Methods: We report a 14-year-old male patient with a history of Ewing sarcoma and metastatic pleural disease who was hospitalized for progressive dyspnea. After careful evaluation, a massive right-sided pleural effusion was found as the underlying cause. Palliative treatment was indicated, which was performed in two stages. First, simultaneous pleural fluid drainage with pleural manometry revealed a malignant effusion. The lung elastance of 5.1 cmH2O/L showed possible lung expansion, without trapped lung syndrome. Due to the recurrence of the effusion, the patient underwent medical thoracoscopy and talc pleurodesis.
Results: Under general anesthesia, 1.2 L of fluid was drained via thoracoscopy. Metastatic nodules were visualized on both visceral and parietal pleura. Two grams of sterile talc were insufflated across the pleural surfaces, which symptomatic improvement.
Conclusion: This case demonstrates the feasibility and technical approach of talc pleurodesis in a pediatric patient. It highlights the utility of thoracoscopic visualization and palliative pleural management in pediatric oncology, as a valuable tool in pediatric interventional pulmonology.