Non-expandable lung in malignant effusion — SCE Respiratory MCQ

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HardPleural DiseaseNon-expandable lung in malignant effusionSCE Respiratory

A 69-year-old woman with metastatic breast cancer has recurrent symptomatic pleural effusion. Pleural aspiration relieves dyspnoea for 5 days, but post-drainage ultrasound shows non-expandable lung with persistent basal pneumothorax ex vacuo. What is the most appropriate management?

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Correct answer: D — Indwelling pleural catheter

The best answer is “Indwelling pleural catheter”. Indwelling pleural catheter is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Talc slurry pleurodesis”, “Repeated high-volume aspiration every week”, “Immediate surgical decortication”, “Observation in the absence of symptom-directed drainage”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1