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Subcutaneous thoracentesis utilizing an Ommaya reservoir in amyloid cardiomyopathy.

RECURRENT, clinically significant pleural effusions developing in benign and malignant disorders require either repeated thoracentesis or ablation of the pleural space. The former is associated with a risk of pneumothorax and infection, the latter with constitutional symptoms at the time of sclerosis. We recently treated a man whose clinical problems included infiltrative cardiomyopathy, lifethreatening severe pleural effusions, and supine and orthostatic hypotension secondary to primary amyloidosis. 1 Attempts to manage these problems with sodium restriction, diuretics, inotropic agents, and electrical pacing were inadequate and necessitated repeated thoracentesis. Pleural sclerosis was rejected because of two concerns. First, anecdotal reports of procedure failure in effusions secondary to congestive heart failure were known. Second, we believed that pleural ablation might lead to worsening of the contralateral pleural effusion or development of a pericardial effusion. Ommaya reservoirs as currently employed allow access to the cerebral ventricles, allowing for simple and safe sampling of cerebrospinal