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Management of Malignant Pleural Effusions—The Effusion Strikes BackA Teachable Moment

Educational Objective
To describe the natural history of malignant pleural effusions (MPEs) and recommended course of treatment.
1 Credit CME

A 66-year-old woman was referred to the pleural clinic for a recurrent malignant pleural effusion (MPE). She had metastatic non–small cell lung cancer that progressed despite several lines of systemic therapy. She presented with worsening dyspnea due to a large right-sided MPE and underwent therapeutic thoracentesis of 1 L with symptomatic improvement. Her effusion recurred every 2 to 3 weeks with associated dyspnea, prompting emergency room or oncology visits for repeat thoracentesis at almost a monthly interval. After 6 thoracenteses, she was referred to the interventional pulmonary clinic at McGill University Health Centre for definitive management and found to have a multiloculated effusion, potentially owing to repeated thoracenteses. An indwelling pleural catheter (IPC) was inserted in the largest loculation with some symptomatic relief. Because of the loculations, there was only partial lung reexpansion, which resulted in suboptimal drainage and limited symptom relief. Nonetheless, the IPC allowed the patient to have regular MPE drainage at home and prevented further hospital presentations for repeat thoracentesis.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Amr J. Alwakeel, MBChB, Pulmonary Medicine Division, Department of Medicine, King Faisal Specialist Hospital and Research Center (Gen Org), PO Box 40047, Jeddah 21499, Saudi Arabia (amr.alwakeel@gmail.com).

Published Online: December 20, 2021. doi:10.1001/jamainternmed.2021.6775

Conflict of Interest Disclosures: Dr Shieh reported personal fees from Novartis, AstraZeneca, and Bristol Myers Squibb outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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