My husband has metastatic NSCLC with malignant pleural effusion. We did see a great improvement in the effusion with treatment, but he seems start accumulating it again. I hope this is still slow accumulation which will not require pleuredosis or a catheter. The previous thoracentesis was complicated by a pneumothorax, and was drained with a chest tube and suction. That was before treatment started and they decided not to have a pleuredosis, hoping the effusion will resolve with treatment, which it did, at least for a while.
My questions:
1. Is he at an increased risk of a pneumothorax from thoracentesis the next time?
2. The previous procedure was done by a pulmonologist and was not US-guided, just x ray. Will we lower the risk of a pneumothorax or other complications if we have a radiologist do the procedure?
thanks
snail
Reply # - September 6, 2015, 09:36 AM
Hi snail,
Hi snail,
An interventional radiologist might perform the procedure, but it seems what you're really looking for is the use of a more precise imaging modality during the procedure, which could be used by a pulmonologist. There is always the risk of pneumothorax, not necessarily greater for each procedure, although of course the more times you repeat the procedure the greater your overall risk.
JimC
Forum moderator
Reply # - September 6, 2015, 10:29 AM
Thanks JimC. You are
Thanks JimC. You are referring to the subsequent procedures as mathematically independent events, my question is whether there might be some anatomic reason - perhaps damage from the disease - that increases his risk.
Who usually performs a thoracentesis? I assume experience is also a factor, even if both use the same imaging.
Reply # - September 7, 2015, 08:32 AM
Hi snail,
Hi snail,
While pneumothorax occurs in a small but not insignificant number of cases, knowing why it occurs in a particular case is difficult to determine. One could imagine that damage from the cancer could lead to a pneumothorax, but you couldn't say for certain, only hypothesize.
Thoracenteses are generally performed by pulmonologists, and you're correct in that the risk is less when the procedure is performed by someone with extensive experience.
It's also true that even if treatment is effective in reducing an effusion, it can wax and wane without ever reaching the point of becoming symptomatic and requiring intervention. My wife's effusion did just that, but she never needed another thoracentesis after the initial one, also performed before treatment began.
JimC
Forum moderator