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Management of Malignant Pleural Effusion Associated with Trapped Lung Syndrome

Department of Thoracic Surgery
¹ Exeter NHS Research and Development Support Unit Royal Devon & Exeter NHS Foundation Trust Exeter, United Kingdom

For reprint information contact: Rizwan A Qureshi, FRCS, Tel: 44 7710 756 103, Fax: 44 121 709 0101, Email: rizwanqureshi2{at}aol.com, 4 Appletree Close, Catherine De Barne, Solihull B91 2TQ, United Kingdom.

Management of recurrent malignant pleural effusion associated with trapped lung syndrome remains problematic. An alternative treatment using a pleural catheter has been advocated. Between August 1999 and August 2002, 127 patients underwent thoracoscopy for malignant pleural effusion. Of these, 52 (41%) with trapped lung were managed by insertion of a pleural catheter. Mean age was 66 years (range, 42–89 years). The most frequent diagnosis was breast cancer. Spontaneous pleurodesis (drainage < 10 mL) occurred in 25 (48%) patients whose catheter was removed after 30 to 255 days (mean, 93.8 days). Symptomatic relief was achieved in 49 (94%) patients. Mean dyspnea score improved significantly from 3.0 to 1.9. Complications comprised catheter blockage, surgical emphysema, cellulitis, and loculated effusion in 2 patients each. Mean length of hospital stay was 3 days (range, 1–16 days). Median survival was 126 days (range, 10–175 days). We conclude that long-term placement of a pleural catheter provides effective palliation for malignant pleural effusion associated with trapped lung syndrome.