Imaging description

Talc pleurodesis is used to manage symptomatic benign and malignant pleural effusions, as well as recurrent pneumothoraces [1, 2]. Talc can be administered via chest tube or by insufflation during thoracoscopy [1]. It works by inciting an inflammatory reaction that results in adherence of the visceral and parietal pleura [2]. CT after talc pleurodesis typically shows high-attenuation areas along the pleura, more often linear than nodular, that are often most prominent in the posterior basal regions [2]. The high-attenuation material may also extend up to the apices, along the mediastinum, or within the fissures [Figures 69.1 and 69.2] [2]. The appearance of talc pleurodesis deposits on CT remains unchanged over time [2, 3]. Patients with residual pleural effusion may demonstrate high-attenuation talc along both the parietal and visceral surfaces around the pleural effusion on CT, giving a variant of the split pleura sign [2]. Talc pleurodesis deposits may show increased FDG uptake on PET, presumably due to secondary pleural inflammation [3, 4].

Importance

Correct identification of the CT appearance of talc pleurodesis is important not only for the sake of accuracy, but also because adhesions from a prior talc pleurodesis procedure may complicate or preclude thoracoscopy or lung transplantation [1]. In addition, it is important to not confuse imaging findings of talc pleurodesis with more serious diseases such as empyema or metastases [2–4].