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Malignant pleural effusion with non-expandable lung — SCE Respiratory MCQ

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ModeratePleural DiseaseMalignant pleural effusion with non-expandable lungSCE Respiratory

A 69-year-old woman with metastatic breast cancer has recurrent dyspnoea from a right pleural effusion. Two therapeutic aspirations give symptom relief but post-drainage imaging shows persistent visceral pleural thickening and incomplete lung expansion. Pleural fluid cytology is malignant. What is the most appropriate management?

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Correct answer: B — Indwelling pleural catheter

Recurrent malignant effusion with non-expandable lung is best managed with an indwelling pleural catheter for symptom control. Talc pleurodesis requires pleural apposition and is less successful when the lung does not expand. Repeated aspirations are burdensome, lobectomy is not relevant and fibrinolytics treat selected infected or septated pleural collections rather than malignant trapped lung.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/