Stage 4 NSCLC with pleural effusion and air leak. - 1247624

Mon, 09/03/2012 - 14:43

New here and not sure where to post. My brother has stage 4 NSCLC with plueral effusion. He has had pleurodesis using talc. The surgeon informed us that the cancer is external on the lung, in the pleural space and large and irregular shape.
Chest tube inserted and after 7 day of continuous drainage (tea colored) , sent home with Pneumostat chest drain valve for home drainage..
Complicating factor is that there is an air leakage in the lung that we are told must heal before the chest tube can be removed (and before any chemo can begin)... IN ADDITION to stemming the pleural effusion to 100 ML per 24 hours. Daily x-rays show no improvement with the air leakage although my brother is breathing much better with the drainage of the fluid. Surgeon says tumor has caused too much space in cavity for pleurodesis to be effective enough to stop the effusion. And there really is nothing further he can do but hope the lung heals enough to close the leak (and remove the chest tube) I hope I am being explicit enough. Our hope was to get the pleural effusion under control so chemo could be started. Will be seeing the oncologist 10 days from today (Labor Day). Is it possible for such an air leak to heal and close on its own? As for the pleural effusion, it is the cancer that is causing the fluid build up.
Thank You

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Dr West
Posts: 4733

Yes, it's possible for the air leak to close on its own.

The tumor itself is almost certainly the underlying cause of the effusion.

I'm sorry there isn't more to suggest. This is a situation in which there just aren't a lot of interventions to offer. I can see if Dr. Farivar, a great thoracic surgeon with whom I work, has any thoughts about further management options.

-Dr. West

Posts: 6

Thank you Dr. West. As many have said...One day at a time..... A tip for wearers of the Pneumostat chest drain valve. My brother had trouble sitting in his favorite and comfortable chair because the valve would leak when laying at an angle, especially when he coughed. We found a plastic bottle (Spic and Spam 20oz narrow bottle), cut about a 3rd off the top and wedged it between the cushion and arm rest. The valve sits nicely in it's plastic "pocket" and stays straight up and in place. He sleeps much better in "his" chair!..We also pinned an old apron to the side of his bed with the pocket just at the right height to hold the drainage bottle valve up right. (when he sleeps on his back......a different story when he rolls on his side.....working on a solution for that!)

certain spring
Posts: 762

210ben, I'm sorry to hear about your brother. But impressed by your inventive solutions!
By the way, this is definitely the right place to ask questions, rather than as a Comment on one of the doctors' blog posts - a question will get seen and answered quicker if it's posted in the Forums.
Best to you and your brother, and hope the air leak heals.

Posts: 5

This is a difficult problem to manage sometimes. The lung heals better if it touches the chest wall. In this circumstance that cant happen bc of a restrictive process by the cancer on the lung. I have had success in the past managing this issue with a pleurx drain. This is a soft drain tunneled to exit on the abdominal wall but it sits in the pleural space. It could allow your brother or family to be taught to drain air/fluid on a daily basis until the lung heals (hopefully w time). It is more comfortable than a chest tube. All old sites (portals to the chest) must be closed securely and be fluid tight so no further fluid leaks occur once the pleural drain is in place. Talc never works if the lung cant reexpand to touch the chest wall. This circumstance necessitates a pleurx drain. To add an air leak to that circumstance makes it a much more complicated matter. I cant guarantee this will work (it also depends on how big the air leak is and whether the patient tolerates the pneumothorax) but I suspect it may and be more comfortable than the chest tube. Infection of the pleurx is a possibility with an air leak (<10%) which could necessitate its removal down the line. A pleurx can be removed without much trouble once there is no longer a function for it (i.e. to drain fluid, or in this case fluid and air). Best of luck. This is not a common or well known application for a pleurx. It is just a novel approach to a difficult to manage problem.

Posts: 6

Hello: Well, both the thoracic surgeon and my brothers oncologist agree that my brothers air leakage will not close. The surgeon has pulled the chest tube out slightly and says he will continue to slowly remove the tube over time AS my brother begins chemo...his oncologist will begin probably in a week or two. Last week the oncologist said he had never heard of an air leak not healing. We are told the air leak is too large to heal. Either that is true or it would heal absent the tumor. Though not shown the x-ray, i suspect the hole is located very near or even at the tumor site). Is anyone aware of this type of air ever (or never) healing? I pray that my brother tolerates the chemo enough to get some quality of life in whatever time it may buy .I do not know the treatment regime..awaiting the genetic test results.

Posts: 1

I understand your situation 210Ben. Right now I am in the hospital with a chest tube waiting for my leak to heal. Had to start chemo here, and am currently just waiting for leak. The surgeon talked me out of a talc procedure, and just told me to continue to get chest tubes.

Posts: 6

To all: Update on my brothers status: Surgeon decided to gradually remove chest tube,,,he has started Chemo.....(1st infusion- Avastin, Alimta, Caroplatin) it appears the chemo has (apparantly) slowed the plueral efffusion...But not the air leak.....(while waiting for an x-ray, the tube actually FELL out on it's own!)....
optimistic but tired (the chemo-as expected)......