mkrasner
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Are there any options for re-inflating a lung that has not inflated after multiple thoracentesis procedures? Is pleurodesis still an option if the lung won't inflate fully? Looking for something that will still allow the patient to swim, so a permanent catheter is not a good option. Also what's the prognosis when pleural effusion reoccurs every week or so? Primary cancer is ovarian IIIC, with seeding to pleura. No large tumors, 5 years into illness with multiple lines of chemotherapy.
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Reply # - July 9, 2014, 12:19 PM
Reply To: Recurrent Malignant Pleural Effusion with Atelectasis
Hello,
The NIH has this to say about treatment for pneumothorax:
A small pneumothorax may go away on its own. You may only need oxygen and rest.
The health care provider may use a needle to pull the extra air out from around the lung so it can expand more fully. You may be allowed to go home if you live near the hospital.
If you have a large pneumothorax, a chest tube will be placed between the ribs into the space around the lungs to help drain the air and allow the lung to re-expand.
The chest tube can be left in place for several days. You may need to stay in the hospital. However, you may be able to go home if a small chest tube is used.
Some patients with a collapsed lung need extra oxygen.
Lung surgery may be needed to treat your pneumothorax or to prevent future episodes. The area where the leak occurred may be repaired. Sometimes, a special chemical is placed into the area of the collapsed lung. This chemical causes a scar to form. This procedure is called pleurodesis. – http://www.nlm.nih.gov/medlineplus/ency/article/000087.htm
With any luck, a pleurodesis may help resolve the pneumothorax and prevent future effusions. Certainly worth discussing with the patient's health care providers.
Prognosis is not necessarily a function of the presence and recurrence of the pleural effusion, but rather whether there are (or were) cancer cells in that area. The American Cancer Society has a discussion of ovarian cancer staging here: http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer…
JimC
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Reply # - July 9, 2014, 04:25 PM
Reply To: Recurrent Malignant Pleural Effusion with Atelectasis
This issue of the lung not reinflating after the fluid is removed usually means that the cancer itself is mechanically limiting the lung function, such as air can't get in through the bronchial tree to inflate the lung, or there is scarring around the lung that limits its mobility. When that happens, a pleurodesis isn't likely to be effective, since it really requires the outside of the lung to be closely apposed to the inside of the chest wall to create the adhesions needed to have a pleurodesis work as it's supposed to.
The prognosis isn't directly related to the effusion, but the rapidity of fluid reaccumulation is, in some way, a reflection of the status of the cancer -- the cancer tends to be moving forward when it's producing a lot of fluid. At the same time, removing lots of fluid also entails removing protein, which can lead to malnutrition and immune compromise over time.
A PleuRx drain may well be the best option, regardless of the appeal of swimming, at least other than coming in frequently for a thoracentesis.
Good luck.
-Dr. West