S. Mckaya (Dr), P. Mullenixa (Dr), E. Briggsa (Dr), R. Coopera (Dr), R. Browning*a (Prof)

a Walter Reed National Military Medical Center, Bethesda, UNITED STATES

* robert.f.browning.jr@gmail.com


The most common indication for indwelling pleural catheters (IPC) is relief of dyspnea in malignant pleural effusions. In some cases, IPCs not only provide improvement in quality of life but also allow more time for additional treatment. The development of a new targeted treatment for KRAS positive NSCLCA that was previously thought to be “untargetable” highlights the value extending survival as a bridge to new therapies.

Case Report

A 56 year old female with stage IVb adenocarcinoma (KRAS positive) who presented with a large right upper lobe cavitary tumor encompassing the entire upper half of the right thorax and a very complicated pleural space with a malignant pleural effusion and a collapsed RLL. Stent was placed in the RMB to open the RLL and IPC was placed using guidewire, ultrasound and fluoroscopy to drain the dependent and apical loculated pleural effusions. Over the next 18 months, the IPC was simultaneously used to manage not only the malignant pleural effusion but a chronic slowly expanding pneumothorax likely from an alveolopleural fistula (APF) from the apex of the RUL cavity after radiation and initial tumor response to therapy as well as a pseudomonal empyema that was treated with IV antibiotics and daily drainage from the IPC. During this time, the patient continued immunotherapy/chemotherapy followed by Docetaxel and Ramucirumab all with progression of disease within the lung and bones. In July of 2021 she was one of the first patients to receive Sotorasib C2 off trial. She experienced a dramatic response and remains clinically improved now 10 months later.


Indwelling pleural catheters can strategically be placed using ultrasound and fluoroscopic imaging in very complex pleural spaces and managed to treat multiple pleural complications encountered in advanced lung cancer patients and act as a bridge to newer therapies.

Disclosure of funding source(s): none