Clapper, Patti, Schweizer and Mason

One of the main symptoms of pleural mesothelioma is difficulty breathing and lung compression due to fluid build up and tumor growth in the chest cavity.  This symptom is known as pleural effusion and can cause serious pain and dyspnea.  When the first line of palliative treatment, often a thoracentesis, is ineffective at providing symptom relief, two other procedures may be tried:  a pleurodesis or placement of an intrapleural catheter (Pleurx).

Usually after a thoracentesis and determination of what is causing pleural effusion, a thoracic surgeon is recommended to perform a chemical pleurodesis.  The chemical, a sclerosing agent, is introduced through a chest tube and inserted between the two layers covering the lung.  Sclerosing agents, such as talc, bleomycin, and providone iodine,  are intended to cause irritation which creates an obliteration in the space, preventing fluid from being able to re-accumulate in that space. 

A pleurodesis can be performed at the bedside or in the operating room, under local anesthesia and/or sedatives.  A chest tube is then inserted that allows fluid to drain.  After adequate drainage, a chemical solution is added and then the patient is asked to alter positions to allow the agent to be fully distributed within the cavity.   The goal is to expand the lung and prevent fluid from continually filling the space.

An additional treatment is a tunneled intrapleural catheter, where a small drainage tube is inserted by the surgeon.  The tube is then connected to a Pleurx, a suction bulb device.  The patient is instructed on how to drain the fluid from the Pleurx until the lung re-expands, which usually takes 2 to 3 weeks.   Ideally, the tube can then be removed with little chance of reaccumulation of fluid.  If the lung is entrapped, the surgeon may opt to keep the tube in place versus remove it.

There are some risks involved in either procedure that patients should be made aware of so that they can weigh the benefits and make informed choices with the help of their surgeon.  Both can be extremely effective at providing symptom and pain relief.