Abord de l'épanchement pleural métastatique symptomatique cas clinique interactif

Metastatic pleural effusion (MPE) is a frequent feature of advanced cancer. Consequences of MPE, such as dyspnea and cough, deteriorate the patient's quality of life and palliation, aiming alleviation of breathlessness, is one of the major goal of therapy. One of the commonest mechanisms for the development of MPE is the inability of the parietal pleura to reabsorb pleural fluid because of involvement of mediastinal lymph nodes. The other possible causes include direct tumor invasion and hematogenous spread to the parietal pleura. Recent studies have shown another pathway to MPE formation involving a loop of interactions between pleural-based tumor cells and the host vasculature and immune system resulting in increased fluid production via enhanced plasma extravasation into the pleural space. Current therapeutic options include removal of the pleural fluid by iterative thoracentesis or pleural drainage. Recently the use of long-term indwelling pleural catheter have shown to be a cost-efficient procedure allowing outpatient or minimal hospital stay improving patients'quality of life. The other current method for the treatment of MPE aims to obliterate the pleural cavity. Talc is the gold-standard for a chemical pleurodesis through a chest tube or during a thoracoscopy procedure. However all these standard palliative methods are suboptimal with few drawbacks leading to consider the role of excessive plasma leakage through hyperpermeable pleural network as critical mechanism for MPE formation. Inflammatory mesothelial and endothelial cell in the pleural environment interact with tumor cells leading to MPE formation. The new targets for the treatment of MPE in the future will be several mediators enrolled in this biological cascade.