MANAGEMENT OF INFECTED MALIGNANT HYDROPNEUMOTHORAX AFTER ENDOBRONCHIAL VALVE PLACEMENT

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Guidelines remain unclear on use intrapleural thrombolytics in infected malignant pleural effusion. We present a case epithelioid mesothelioma with effusion, who presented bronchopleural fistula (BPF) needing endobronchial valves. He later developed enterococcus empyema loculations and tunneled catheter (TPC) placement. CASE PRESENTATION: A male aged 86 recently diagnosed was transferred to our hospital for pneumothorax BPF occurring as complication serial thoracenteses performed due reaccumulating On arrival patient's vitals were stable lab tests within normal limits. underwent valve placement excellent results resolution air leak. Post-procedurally, hydropneumothorax persisted imaging demonstrated trapped lung. The chest tube removed he followed up clinic 2 weeks. return visit clinically improved, however bedside ultrasound revealed persistent interval development loculations. readmitted blood work leukocytosis 19800 cells/mm3. Pleuroscopy lysis adhesions performed. TPC then inserted under direct visualization. Two doses tissue-plasminogen activator (tPA) DNase instilled through catheter. Pleural fluid cultures grew pan-sensitive antibiotics tailored accordingly. follow-up weeks later, reported symptomatic improvement noted significantly decreased effusion sparse continues drain every 3 days at home asked complete 6 oral amoxicillin-clavulanate. DISCUSSION: Patients are complicated manage have median survival 12 months. Our patient required bi-weekly thoracentesis leak before transfer allow healing BPF. Persistent lung is another complication, resulting potential space pleura nidus infection. This also occurred managed mechanical during pleuroscopy chemical using tPA/DNase therapy TPC. thus able Pleuroscopy, significant quality life. CONCLUSIONS: effusions fraught complications, including lung, hydropneumothorax, infections. demonstrates importance multidisciplinary care utility managing these patients. REFERENCE #1: Aydin Y, Turkyilmaz A, Intepe YS, Eroglu A. Malignant effusions: appropriate treatment approaches. Eurasian J Med. 2009;41(3):186-193. DISCLOSURES: No relevant relationships by Sharjeel Israr, source=Web Response Daniel Kim, Ali Saeed, Hursh Sarma, Anup Solsi, Cindrel Tharumia Jagadeesan,