Malignant pleural effusion, ascites and cardiac tamponade
Recognising and draining malignant pleural, peritoneal and pericardial fluid; IPC versus talc and the trials behind them, the LENT score, SAAG in malignant ascites, and the echo signs and management of malignant tamponade.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Malignant fluid in the pleura, peritoneum or pericardium usually means advanced, incurable disease. Goals are symptom relief, fewer procedures and less time in hospital.
- Pleural: drain to relieve breathlessness, then choose between an indwelling pleural catheter (IPC) and talc pleurodesis based on lung expansion, prognosis and preference.
- Peritoneal: paracentesis, then a tunnelled peritoneal catheter if it keeps coming back quickly.
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Sources
- Therapeutic Guidelines: Oncology and Palliative Care (malignant effusions)AU/NZTherapeutic Guidelines Ltd
- eviQ Cancer Treatments Online (oncological emergencies)AU/NZCancer Institute NSW
- British Thoracic Society Guideline for pleural diseaseBritish Thoracic Society (Thorax 2023), 2023
- Bibby AC et al. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J 2018;52:1800349European Respiratory Society and European Association for Cardio-Thoracic Surgery, 2018
- Schulz-Menger J, Collini V, Gröschel J et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. Eur Heart J 2025;46(40):3952-4041European Society of Cardiology, 2025
- Thomas R et al. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion (AMPLE). JAMA 2017;318:1903-12JAMA, 2017
- Muruganandan S et al. Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2). Lancet Respir Med 2018;6:671-80Lancet Respiratory Medicine, 2018
- Bhatnagar R et al. Outpatient talc administration by indwelling pleural catheter for malignant effusion (IPC-PLUS). N Engl J Med 2018;378:1313-22New England Journal of Medicine, 2018
- Clive AO et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 2014;69:1098-104Thorax, 2014
- Eberhardt WEE et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol 2015;10:1515-22International Association for the Study of Lung Cancer, 2015 (eighth edition)
- Last updated
- 14 November 2026
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