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Malignant pleural effusion with trapped lung — SCE Respiratory MCQ

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HardLung cancerMalignant pleural effusion with trapped lungSCE Respiratory

A 70-year-old man has a persistent unilateral pleural effusion and pleural nodularity on ultrasound. He is breathless at rest, and diagnostic aspiration confirms metastatic adenocarcinoma with pleural fluid pH 7.28. After 1.2 L therapeutic aspiration, chest radiograph shows incomplete lung re-expansion and he develops a dull ache. He wants a community-manageable symptom strategy. What is the most appropriate management?

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Correct answer: C — 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 pleurodesis in the setting of non-expandable lung”, “Repeated large-volume aspiration as sole planned care”, “Emergency thoracotomy and decortication”, “Empirical antituberculous therapy”—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: NICE NG122 lung cancer: diagnosis and management: https://www.nice.org.uk/guidance/ng122/chapter/Recommendations