Autologous Blood Pleurodesis Through an Indwelling Pleural Catheter for the Management of Prolonged Air Leak in a Malignant Hydropneumothorax

The British Thoracic Society guidelines recommend a surgical opinion in cases of prolonged air leak or failure of lung re-expansion after 3-5 days. The management of prolonged air leak in non-surgical candidates often proves to be more challenging, with no expert consensus guidelines on treatment options. There is a paucity of data for the treatment of patients with a prolonged air leak in the setting of a hydropneumothorax, who are not suitable surgical candidates. We present the case of a novel treatment approach for an 89-year-old male with a symptomatic, large malignant pleural effusion treated initially with a routine chest tube drainage. Subsequent management was complicated by a hydropneumothorax with a persistent and large volume air leak. He was treated successfully with an autologous blood pleurodesis using an indwelling pleural catheter. Here we describe a novel management approach for persistent air-leak in the setting of a malignant hydropneumothorax. Autologous blood pleurodesis via an indwelling pleural catheter appears to be a safe and effective treatment option for non-surgical candidates and allows ongoing long-term drainage of a malignant effusion and air leak.