Indwelling pleural catheter enabling safe air travel in malignant pleural effusion with pneumothorax ex vacuo

Pneumothorax of any cause typically represents a contraindication to air travel. Pneumothorax ex vacuo is often encountered in clinical practice due to non-expandable lung, a common finding in malignant pleural effusion (MPE). The presence of intrapleural air may prevent people diagnosed with terminal illness from participating in air travel. We present the case of a man with pleural mesothelioma who developed a large left hydropneumothorax following initial drainage of MPE. An indwelling pleural catheter (IPC) was placed on subsequent presentation. As the patient wished to undertake a domestic flight with his family, we established a protocol which allowed management of emergent symptoms and the in-flight risk of intrapleural air expansion. This case demonstrates that in carefully selected patients with MPE, pneumothorax ex vacuo and a functioning IPC, air travel may be feasible. Beyond the physiological considerations, the patient was able to fulfil a final trip with his family.