Mesothelioma — SCE Medical Oncology MCQ
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Correct answer: C — Insert a tunnelled indwelling pleural catheter for ambulatory drainage
A tunnelled indwelling pleural catheter controls recurrent malignant fluid even when trapped lung prevents successful pleurodesis. Insert an intercostal drain and perform talc slurry pleurodesis: pleurodesis is unlikely to succeed when the visceral and parietal pleura cannot appose. Insert an intercostal drain and perform thoracoscopic talc poudrage: thoracoscopic poudrage also depends on adequate lung re-expansion. Arrange repeated ultrasound-guided thoracentesis at each symptomatic recurrence: serial taps are less suitable than ambulatory continuous control for frequent recurrence. Arrange surgical decortication followed by talc pleurodesis: major surgery is disproportionate palliative management in most malignant trapped-lung cases.
Reference: British Thoracic Society guideline for pleural disease (Published November 2023; current BTS guidance): https://thorax.bmj.com/content/78/11/1143; NICE NG122 lung cancer: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng122/chapter/Recommendations