Malignant Pleural Effusion

Question 1

History in malignant pleural effusion

Answer 1

• SOB: Slow or rapid deterioration in breathing and ET
• Chest pain: may be pleuritic, may be central and tight, may be insidious ache that keeps awake overnight
• Cough: may produce clear mucus
• May have weight loss, night sweats
• May be other historical features

Question 2

Examination in malignant pleural effusion

Answer 2

• O2 sats may be low or maintained, patient may be tachycardic with low BP if massive pleural effusion
• Decreased expansion, dull to PN, decreased AE on affected side.
• Signs of primary cancer or of treatment (e.g., scars, radiotherapy changes), lymphadenopathy, metastatic disease
  (hepato/splenomegaly)

Question 3

Investigations in malignant pleural effusions

Answer 3

-Blood tests: Signs of cancer presentation e.g., hyponatraemia, hypercalcaemia, anaemia, deranged LFTs, coagulation studies prior to a procedure
* USS: Can be simple or complex, can be unilateral or bilateral, can be small or large. May be other findings: pleural nodularity, liver metastases, pericardial effusion
* USS Guided aspiration of pleural fluid
* CT – Chest/Abdomen/Pelvis – Where is the primary?

Question 4

Characteristics of malignant pleural effusions

Answer 4

-Bloody
-Milky (lymphatics- chyle)
-Cloudy/ serous

Question 5

Treatment aims for malignant pleural effusion

Answer 5

1. Treatment of underlying cancer
2. Management of pleural effusion

Question 6

Surgical techniques in malignant pleural effusion

Answer 6

-Therapeutic thoracocentesis
-ICD and pleurodesis
-Tunnelled pleural catheters

Question 7

Problems with pleurodesis

Answer 7

-High output effusion
-Trapped lung
-Drain failure
-Deterioration