Malignant pleural effusion (MPE) is a common and complex manifestation of advanced stage
cancer. Treatment options have trended towards less invasive approaches such as intrapleural
catheter drainage, however this technique is not without morbidity and not suitable for every patient. A troublesome scenario arises when an MPE is secondarily infected in the setting of an
indwelling catheter, given both the high frequency of recurrence of such fluid and the presence of a
foreign body. Further, quality literature surrounding this specific management issue is sparse and thus practice is heterogeneous. Herein we presented a case report of a 74-year-old gentleman with secondarily infected MPE and subsequent failure of indwelling pleural
catheter (IPC) drainage. Given multiple failures of his
catheter, we performed an open window
thoracostomy (OWT) to provide a durable method of draining the pleural space and concomitantly achieving source control. OWT represents an infrequently described but invaluable alternative measure the surgeon may take when faced with failure of intrapleural
catheter drainage and trapped lung.