Malignant Pleural Effusions David Hsia, MDAli I. Musani, MD Author and Disclosure Information [Show] David Hsia, MDAssociate Clinical Professor, Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CAAli I. Musani, MDProfessor, Departments of Medicine and Pediatrics, Director, Interventional Pulmonology Program, National Jewish Health, Denver, CO Question 1 of 5 A 68-year-old woman undergoing chemotherapy for ovarian cancer is evaluated for progressive dyspnea with exertion and nonproductive cough for the past 3 months. She was able to perform all of her activities of daily living without assistance prior to the onset of her symptoms. Chest radiograph demonstrates a large, free-flowing right-sided pleural effusion. Thoracentesis is performed and 500 mL of serosanguinous-appearing pleural fluid are removed. The procedure is concluded after the flow of fluid slows and then finally stops. The patient describes a pressure-like discomfort in her chest just prior to the cessation of pleural fluid removal. Manometry measurements near the end of the procedure show a pleural pressure of –25 cm H2O. Post-procedure chest radiograph shows that a moderate-size pleural effusion remains.What is the best therapeutic approach to palliate this patient’s symptoms? Choose one Serial thoracentesis as needed to relieve symptoms Insertion of a tunneled pleural catheter for intermittent fluid drainage Placement of a chest tube to drain remaining fluid followed by talc slurry pleurodesis Thoracoscopy with visual confirmation of complete fluid drainage and talc poudrage This quiz is not accredited for CME.