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Intrapleural Tissue Plasminogen Activator and Dornase Alfa Administration for a Multiloculated Recurrent Malignant
Kia Nikoomanesh1, Alexander T Phan2, Veerpal Sond2
1Pulmonary and Critical Care, Arrowhead Regional Medical Center, Colton, USA.
Abstract:
Malignant pleural effusions (MPEs) can often be very difficult to manage despite conservative interventions including thoracentesis and indwelling pleural catheter placement. These effusions can be septated and loculated, leading to complexities in drainage and symptomatic relief for patients. As such, physicians have experimented with the use of tissue plasminogen activator (t-PA) and dornase alfa (DNase) in attempts to drain complex malignant pleural effusions. Although the use of t-PA and DNase has been well studied in the context of empyema, the literature is limited in regards to the use of these medications in MPEs. Here, we present the case of a patient with a history of metastatic lung adenocarcinoma complicated by recurrent MPEs. Bedside ultrasonography revealed a septated fluid pocket in the pleural space of the right hemithorax. An indwelling pleural catheter (IPC) was placed with minimal symptomatic relief. The decision was made to administer t-PA and DNase through the IPC, resulting in the resolution of symptoms and radiographic findings. This case highlights the potential benefit of using t-PA and DNase to help drain complex malignant pleural effusions.
Insights
This case study shows that combining tissue plasminogen activator (t-PA) and dornase alfa (DNase) via an indwelling pleural catheter (IPC) can effectively manage complex malignant pleural effusions (MPEs). This approach offers a potential solution for challenging MPE drainage and symptom relief.
Area of Science:
- Pulmonology
- Oncology
- Thoracic Surgery
Background:
- Malignant pleural effusions (MPEs) pose significant management challenges, often resisting standard treatments like thoracentesis and indwelling pleural catheters (IPCs).
- Complex MPEs characterized by septations and loculations complicate fluid drainage and patient symptom resolution.
- Existing literature on tissue plasminogen activator (t-PA) and dornase alfa (DNase) primarily focuses on empyema, with limited data on their use in MPEs.
Observation:
- A patient with recurrent MPEs secondary to metastatic lung adenocarcinoma presented with a septated right hemithorax effusion.
- Initial IPC placement provided only minimal symptomatic improvement.
- Bedside ultrasonography confirmed a loculated effusion, necessitating further intervention.
Findings:
- Intrapleural administration of t-PA and DNase through the existing IPC was performed.
- This therapeutic approach led to complete resolution of the patient's symptoms.
- Radiographic imaging confirmed successful drainage and resolution of the pleural effusion.
Implications:
- The combination of t-PA and DNase delivered via IPC presents a promising strategy for managing complex, loculated malignant pleural effusions.
- This case suggests a potential therapeutic avenue for improving outcomes in patients with refractory MPEs.
- Further research is warranted to validate the efficacy and safety of this treatment modality in a larger patient cohort.
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