Insertion of a Right-Sided PleurX Catheter for Palliation of a Malignant Pleural Effusion
Andrew S. Chung, MD, PhD; Hugh G. Auchincloss, MD, MPH
Massachusetts General Hospital
The following case describes a 91-year-old woman with no significant past medical history who presented to her primary care physician with several months of cough and progressive dyspnea. After appropriate workup she was found to have a stage IVa lung adenocarcinoma with an associated malignant pleural effusion that contributed to her symptoms. There are several therapeutic options for treating a malignant pleural effusion. An indwelling tunneled pleural catheter (PleurX catheter) is a reliable way to manage a chronic pleural effusion. The device is most commonly used to manage malignant pleural effusions, but the same technique may be applied for a range of benign, non-infectious indications as well.
PleurX catheters may be inserted in an outpatient clinic, interventional radiology suite, inpatient setting, or operating room under local or general anesthesia. Once in place, they are designed to be managed in an outpatient setting either by the patient’s caregivers or by the patient themselves and serve to palliate the respiratory symptoms of a large effusion without the need for repeated thoracenteses. They can remain in place for several months, and removal in an outpatient setting with local anesthetic is trivial. Following placement of the PleurX catheter, the patient reported symptomatic improvement in her dyspnea, and she was started on dose-reduced Mobocertinib under the guidance of thoracic oncology.
