Pleural Catheter - 1266252

suejg
Posts:19

My husband, Gary, started using an in-dwelling pleural catheter (PleurX brand) in August for treatment of his malignant pleural effusion. The drainage gradually lessened and then became increasingly thick (no color change). It got to the point that we could get very little fluid, and it was very thick and heavy. Now we can get nothing. There is no blockage visible in the exterior portion of the drain. An x-ray yesterday showed that there is still some effusion present (described as a "moderate" amount). Gary feels fine with no shortness of breath, but usually he doesn't become symptomatic until the effusion becomes very large.

We are hoping that this represents the pattern of a pleural effusion that is "drying up." I have also heard of effusion being loculated and wondered if that could explain the remaining effusion with no further drainage. We saw our oncologist yesterday, and she offered no insights. Tomorrow we will see the investigational radiologist (IR) physician who implanted the drain. Based upon the information we have provided, he seems to think that the drain must be plugged and is planning to sedate Gary and perform a procedure to clear the blockage. I am concerned...

We'd really appreciate any insight you may have on this topic. Thank you very much.

Sue

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Reply # - October 1, 2014, 07:50 PM

Dr West
Posts: 4735

It sounds like it's very possible, even likely, that there's some tissue, whether clotted blood or more fibrotic tissue that could be causing this blockage. It's uncommon but not rare. If there's dried blood causing a clot, it may be possible to inject a "lytic" agent to break up the clot -- basically the medical version of Drano into a clogged drain (apologies for the mundane analogy). On the other hand, if it's fibrotic material (scar tissue, general reactive debris), it may be possible to flush it out, but the Pleurx will likely be prone to clogging up again readily. I have at least one patient with this situation of getting it unclogged briefly, only to have it clog up again in less than a week. She's not my first patient with this pattern.

Good luck.

-Dr. West

Reply # - October 2, 2014, 04:27 AM

suejg
Posts: 19

Thank you so much, Dr. West, for taking the time to share this valuable information with us. Gary will undergo investigation and treatment this afternoon. It always makes us feel better going into these new situations prepared with as much knowledge and understanding as possible. Thank you again for your help.

Sue

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