Advances in the Management of Recurrent Pleural Effusions | Dr. Ajay Wagh

📌 Chapters 00:00 Introduction 00:20 Causes of pleural effusion: transudates vs exudates 00:47 Objectives 01:10 Ultrasound in pleural effusion: ERS statement 01:45 DUETS score: separating exudate from transudate on ultrasound 02:40 Sinusoid sign for non-expandable (trapped) lung 03:47 Pleural elastography for malignant effusions 04:57 The PLEASE studies: breathlessness, diaphragm and bendopnoea 08:04 Ultrasound pleural adherence score after IPC or talc 09:16 Why early definitive management of MPE matters 09:49 25 years of MPE trials: IPC vs talc 10:27 2023 BTS guideline algorithm for malignant pleural effusion 10:56 TACTIC trial: talc poudrage + IPC vs poudrage alone 12:55 ERS guidelines: effusions from heart, liver and renal failure 14:20 IMPACT registry: outcomes in organ-failure effusions 15:57 WABIP/AABIP: thoracoscopy vs talc slurry for benign effusions 18:06 Chylothorax consensus: 7 PICO recommendations 19:26 Case: recurrent right pleural effusion 20:44 Take-home points 🫁 How should we be managing recurrent pleural effusions in 2026? Dr Ajay Wagh, interventional pulmonologist at the University of Chicago, reviews the latest evidence across malignant and benign pleural disease. He covers advanced ultrasound (the DUETS score, sinusoid sign, elastography and the pleural adherence score), the PLEASE studies on breathlessness and bendopnoea, IPC vs talc pleurodesis, the TACTIC trial, the 2023 BTS guidelines, the ERS guidelines for heart, liver and renal failure effusions, the WABIP/AABIP thoracoscopy statement and the 2024 chylothorax consensus. He closes with an instructive case of chylothorax. About the Speaker Ajay Wagh, MD, is Associate Professor of Medicine in the Division of Pulmonary and Critical Care at the University of Chicago, where he practises as an interventional pulmonologist and critical care physician. About Virtual Grand Rounds Virtual Grand Rounds is a free weekly webinar series for thoracic surgeons, oncologists, respiratory physicians, and trainees, featuring leading specialists from around the world. Live sessions run Fridays at 8:00am UK time via Zoom, with CME credit available for live attendees. Register here: https://us02web.zoom.us/webinar/regis... Topics Discussed • Recurrent malignant pleural effusion (MPE) management • Indwelling pleural catheter (IPC) vs talc pleurodesis • Talc poudrage vs talc slurry • TACTIC trial (Lancet Respiratory Medicine) • 2023 BTS guidelines for malignant pleural effusion • Thoracic ultrasound: DUETS score, sinusoid sign, pleural elastography • Pleural adherence score after IPC removal • PLEASE studies: hemidiaphragm dysfunction and bendopnoea (bendopnea) • Benign pleural effusion: heart failure, hepatic hydrothorax, ESRD • IMPACT registry • Medical thoracoscopy (pleuroscopy) for benign pleural disease • Chylothorax management consensus #PleuralEffusion #InterventionalPulmonology #MalignantPleuralEffusion #ThoracicUltrasound #RespiratoryMedicine #VirtualGrandRounds