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Malignant Effusion with Trapped Lung — RACP Adult Medicine MCQ

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HardRespiratoryMalignant Effusion with Trapped LungRACP Adult Medicine

A 60-year-old man with mesothelioma develops a large symptomatic malignant pleural effusion (3 L drained on diagnostic thoracentesis). The effusion reaccumulates within 2 weeks. He has a trapped lung (incomplete re-expansion on drainage). Performance status is ECOG 1. What is the most appropriate management?

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Correct answer: D — Intercostal chest drain (small-bore, 10-14 Fr)

Recurrent symptomatic malignant pleural effusion with trapped lung (non-expandable lung preventing successful pleurodesis) is best managed with an indwelling pleural catheter (IPC). Among available options, small-bore chest drain placement (as an IPC analogue) allows ongoing ambulatory drainage. Talc pleurodesis requires lung re-expansion to be effective. IPCs allow home drainage and may achieve spontaneous pleurodesis in ~45%.

Reference: eTG Respiratory – 2024 – Malignant Pleural Effusion; BTS 2023