Your 55 yo female patient (from Japan) with newly diagnosed adenocarcinoma is seeing you back in clinic 9 months later for gradually increasing dyspnea over the past 3 weeks. She has been receiving gefitinib oral therapy. PFTs reveal restriction with a diffusion abnormality.
As part of her evaluation you order a CXR which reveals a large left pleural effusion. You perform thoracentesis and 1.5L of sanguinous fluid was drained. Cytology is positive for malignant cells.
You discuss potential treatment options with the patient regarding the pleural fluid should the effusion reoccur. You discuss both pleurodesis and small bore catheter placement for chronic drainage. Which of the following would predict a high likelihood of failure of pleurodesis to control her pleural effusion?
A) Initial pleural fluid volume occupying >50% of the hemithorax
B) Pleural fluid pH <7.2
C) Trapped lung
D) Gross appearance of blood in the pleural fluid with RBC count >100,000 cells per mm3