A47-29 Thoracoscopic Talc Pleurodesis Using a Lower-cost Alternative to a Pneumatic Atomizer

Abstract Introduction Talc pleurodesis is an effective treatment for malignant pleural effusions and can be administered intrapleurally either as a talc slurry or by insufflating dry talc powder using a pneumatic atomizer. Studies comparing talc slurry instillation through a chest tube with thoracoscopic talc poudrage (TP) in malignant pleural effusion have shown no significant difference in pleurodesis success, though meta-analysis of success in spontaneous pneumothorax show better outcomes in TP. Additionally, when TP is combined with intrapleural catheter (IPC) placement, pleurodesis rates are significantly higher than with talc slurry alone. Despite its increased efficacy, the use of TP can be limited by the high cost of equipment. We present a case of successful pleurodesis using an innovative, low-cost technique for talc poudrage employing a bronchoalveolar lavage (BAL) trap connected to wall medical oxygen for insufflation and a semi-rigid pleuroscope. Case Description A 50-year-old male presented with significant dyspnea due to recurrent bilateral malignant pleural effusions secondary to metastatic adenocarcinoma of suspected gastrointestinal origin. Given the recurrence of effusions requiring increasingly frequent thoracenteses, right-sided medical pleuroscopy with talc poudrage and intrapleural catheter placement was planned. Owing to the lack of access to a commercial poudrage kit, an alternative system using a BAL trap, O2 insufflation, and a semi-rigid pleuroscope was employed. The pleural space was accessed via pleuroscopy, followed by complete drainage and inspection of the pleural cavity. A BAL trap filled with 4 g of dry, sterile, graded talc powder was attached to wall O2 and to the pleuroscope’s suction adapter. The talc powder was insufflated into the pleural space through the pleuroscope to achieve uniform pleural coverage, followed by intrapleural catheter placement. Within 48 hours, pleural fluid output decreased to less than 50 cc per day. The patient remained minimally symptomatic at follow-up, with no recurrence of effusion on imaging. Conclusion The use of low-cost, readily available equipment provides a cost-effective alternative to commercial atomizers and talc poudrage kits. This case demonstrates successful thoracoscopic talc poudrage using a BAL trap connected to medical oxygen for insufflation and a pleuroscope for talc dispersal. While other reports have described alternative low-cost devices for manual insufflation, to our knowledge, no prior case has utilized a BAL trap for direct talc application through the pleuroscope. This approach has important implications for pleurodesis in resource-limited settings. This abstract is funded by: none