Manometry vs Clinical Assessment in the Detection of Trapped Lung in Patients With Suspected Pleural Malignancy

Malignant pleural effusion is a common clinical problem with median survival of approximately 6 months thus efficient management of Malignant pleural effusion is important. In patients with a Trapped Lung, pleurodesis will be unsuccessful and an indwelling pleural catheter should be inserted instead. Accurate detection of Trapped Lung prior to insertion would avoid futile attempts at talc pleurodesis, re-intervention following failed pleurodesis and allow adequate time to plan for an indwelling pleural catheter insertion.Pleural manometry allows direct and objective measurement of intra-pleural pressure during pleural fluid aspiration.The primary aim of this study is to determine whether the addition of digital pleural manometry to clinical judgment, prior to and during local anaesthetic thoracoscopy, results in a clinically meaningful improvement in Trapped Lung detection.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* Informed written consent
* Suspected pleural malignancy requiring investigation by local anaesthetic thoracoscopy

Exclusion Criteria:

* Any contra-indication to local anaesthetic thoracoscopy
* Predicted pleural aspiration volume \< 1 litre, as defined by a maximum pleural fluid depth of \< 4 cm on thoracic ultrasound pre-aspiration
* Known contra-indication to MRI
* Previous attempt at talc pleurodesis
* Pregnancy
* • Renal impairment (eGFR ≤ 30 ml/min)