Malignant Pleural Effusions
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David Hsia, MD
Associate Clinical Professor, Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, CA

Ali I. Musani, MD
Professor, 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?

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.

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