We then proceeded with Chemo/xRt and APC (argon plasma coagulation) to the lesion via bronch. She had some improvement: on a repeat bronch her airways were more patent to the left and a f/up PET post Tx showed good remission. The CT part of the PET showed some re-expansion of the lung with a larger effusion.
We brought her in for a thoracentesis, got ~1.5 L of clear yellow fluid and the post-tap CxR below on the L. I placed a CT and got the Cxr on the R.
It seems she has trapped lung because of the persistent collapse.
The fluid was negative for malignancy and the collapse was due to intrinsic obstruction which is improved. Would you try and offer anything else?
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That really depends on her functional status. She would need a decortication-so the question is: how would she tolerate that surgery. If she's comfortable and not short of breath, and she does not want surgery, then I wouldn't argue with her. If, on the other hand, she is symptomatic, has a poor qualitiy of life, and is willing to accept surgery, than I would send her to the thoracic surgeons.
I might argue to watch her.
The effusion will probably recur, as something will be needed to fill the pleural space.
The surgeons could have difficulty expanding that lung in the OR to get an effective "pleurodesis" after a decortication. Also, the chance of having a prolonged BPF is high and I would hate to send home an elderly lady with end stage lung cancer with a chest tube/Heimlich valve.
So, unless she is really symptomatic, I would argue to watch her.
My husband has a trapped lung; diagnosed with pancreatic cancer, spread to the right lung plurel, 10/17/08. Has had a dozen thorocentisis, had a chest drain for 2 days that only resulted in 500 cc of bloody fluid and then the tube was pulled. Pluredisis not an option now as fluid keeps building and many septations with numerous pockets. Any other options out there? We are looking for a miracle....or aleast some magic.
Suzann M., San Diego
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