| Case no.: | TL-00200 |
| Status: | Live (This case is available for Library users) |
| Title: | Recurrent symptomatic malignant pleural effusion with trapped lung |
| Background: An elderly male chronic smoker was diagnosed to have metastatic adenocarcinoma of lung with right pleural metastasis, druggable mutations including EGFR and ALK were negative. He was treated with systemic chemotherapy. Despite systemic treatment, he presented with recurrent right pleural effusion which resulted in dyspnea. Repeated hospital admissions with chest tube drainage were needed and symptom was relieved after drainage. Chemical pleurodesis was attempted but not successful. Between hospital admissions, he remained ambulatory with good performance status. He expressed wish to minimize hospital visits and stay. CXR as shown. |
 (Click image to enlarge)
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| Question: | Which of the following treatments would be the most helpful to him? |
Possible
answers: |
| (a): | Long term oxygen |
| (b): | Morphine |
| (c): | Repeat chemical pleurodesis |
| (d): | Repeat pleurodesis with blood |
| (e): | Indwelling pleural catheter insertion with ambulatory drainage(specified as the correct answer) | |
| Reason: The patient had recurrent symptomatic malignant pleural effusion with trapped lung (evidenced on CXR). In such circumstances, pleurodesis is deemed unsuccessful due to lack of adequate pleural apposition. Indwelling pleural catheter (IPC) insertion with ambulatory drainage allows patient to perform pleural drainage without repeated hospital visits, prolonged hospital stay and repeated invasive procedures. |
| Further comments: At least 30% of patients with MPE will have trapped lung, likewise, pleurodesis is unsuccessful in up to 30% of patients. The use of an IPC in these patients enable further drainage of fluid, alleviation of symptoms, and avoidance of admission and multiple subsequent procedures. |
| References: |
| 1: | Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(7):839-849. doi:10.1164/rccm.201807-1415ST |
| 2: | Bibby AC, Dorn P, Psallidas I, et al. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J. 2018;52(1):1800349. Published 2018 Jul 27. doi:10.1183/13993003.00349-2018 |
| 3: | No reference 3 given for this case | |
| Key words: |
| 1: | Malignant pleural effusion |
| 2: | Indwelling pleural catheter |
| 3: | Trapped lung | |
| Submitted by: Charles Wong |
Assembly/
Specialty: | Clinical Respiratory Medicine |
| Institution: | Pamela Youde Nethersole Eastern Hospital, HKSAR |
| Address: | 3 Lok Man Road, Chai Wan, Hong Kong |
| Phone: | +852 25956111 |
| Fax: | / |
| Email: | respirologistlesarch@gmail.com |
| Level of difficulty: Basic |
| Willing to answer queries from users until: 29 Nov 2021 |
| Additional notes to APSR Case Reviewers: No note given for this case |
