Malignant pleural effusions (MPEs) can often be very difficult to manage despite conservative interventions including thoracentesis and indwelling pleural
catheter placement. These effusions can be septated and loculated, leading to complexities in drainage and symptomatic relief for patients. As such, physicians have experimented with the use of
tissue plasminogen activator (t-PA) and
dornase alfa (
DNase) in attempts to drain complex
malignant pleural effusions. Although the use of t-PA and
DNase has been well studied in the context of
empyema, the literature is limited in regards to the use of these medications in MPEs. Here, we present the case of a patient with a history of metastatic
lung adenocarcinoma complicated by recurrent MPEs. Bedside ultrasonography revealed a septated fluid pocket in the pleural space of the right hemithorax. An indwelling pleural
catheter (IPC) was placed with minimal symptomatic relief. The decision was made to administer t-PA and
DNase through the IPC, resulting in the resolution of symptoms and radiographic findings. This case highlights the potential benefit of using t-PA and
DNase to help drain complex
malignant pleural effusions.