Pseudomyxoma pleuri as a Surgical Emergency: a Rare Case Report

Abstract

Pseudomyxoma pleuri is a rare condition and it mostly results from secondary involvement of an abdominal pathology. Massive pleural disease impedes cardiopulmonary functions and threatens life. We are reporting our experience about managing a middle-age lady with a known case of Pseudomyxoma peritonei, who presented to causality with progressive breathing difficulty in acute exacerbation and cardiopulmonary compromise.

Novel Use of Bromelain and Acetylcysteine (BromAc®) for Pleural Involvement in Pseudomyxoma Peritonei

“…The symptom burden of PMP largely stems from increasing mucin production that fills the locoregional space [4]. The ability to repeatedly drain that mucin would reduce symptoms in a disease that would inevitably be fatal due to complications arising from compression or erosion of vital organs and structures.…”

“…Unlike ascites or pleural effusions which drain or aspirate easily, the high viscosity of mucin in PMP disease makes this very difficult. Sharma et al [4] described a case demonstrating such difficulty despite the use of a 32-Fr intercostal chest tube.…”

“…PMP has an incidence of 1–3 cases per million with pleural involvement seen in only 5% of patients, which is most commonly the result of diaphragm invasion or entering the pleural space during cytoreductive surgery (CRS) [1-3]. If untreated, progressive mucin production will exert increasing pressure on critical intrathoracic structures leading to worsening symptom burden [4].…”

Long-Term Treatment of Unresectable Pseudomyxoma Peritonei with Multiple Treatments of Intratumoural Bromelain and Acetylcysteine (BromAc^®): A Case Report

“…Percutaneous drainage of mucin may be a non-surgical option for relief of symptoms which are largely due to increasing mucin production and mass effect on surrounding organs [4]. It remains difficult however due to the high viscosity of mucin, with numerous case reports reporting difficulty removing material through medium-bore catheters alone [5, 6]. BromAc is a therapy currently undergoing development which dissolves mucinous tumour masses and allows for extraction.…”