pleurodesis

If a problem keeps refilling the space around the lung, one solution is to abolish the space itself. Pleurodesis deliberately glues the two pleural layers together so there is no longer a gap for fluid or air to collect in — like sticking the two sides of a plastic bag shut so nothing can pool inside.

The bond is created by provoking controlled inflammation between the layers. A chemical irritant, classically sterile talc, is introduced into the pleural space (instilled through a chest tube or sprayed during keyhole surgery); the inflammation it triggers makes the surfaces stick and scar together over the following days. Mechanical roughening of the pleura at surgery can achieve the same end.

It is mainly used for two stubborn, recurrent problems: malignant pleural effusions that keep coming back despite drainage, and recurrent pneumothorax. Success depends on the lung being able to re-expand fully so the surfaces actually meet. It can be painful and cause fever, and because it is largely irreversible, it is reserved for situations where recurrence is likely or proven.