Role of Vats in Management of Malignant Pleural Effusion with Suspected Diaphragmatic Fenestrations

We present a case of 65 years old woman with history of metastatic breast cancer and recurrent right sided pleural effusion. During video assisted Thoracoscopic surgery inspection two diaphragmatic fenestrations were noted with fluid flowing from abdomen to chest. The fenestrations were endoscopically repaired and talc pleurodesis performed. The presence of diaphragmatic fenestrations should be suspected when there is evidence of fluid collection on either side of the diaphragm. Active inspection for diaphragmatic fenestrations is advocated during the VATS procedure otherwise pleurodesis might fail. Simple stitching and talc pleurodesis control such effusions and prevent exacerbation of trans-coelomic spread of malignancy.