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

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.