If a person has a large amount of fluid in the pleural cavity, this indicates the development of a pathological process in the body. To identify a violation, it is necessary to analyze the effusion in several directions. Below is information on what violations the study allows to identify, how to prepare for the biomaterial collection and how to decipher the conclusion issued in the laboratory.
Indications
The pleural cavity is a small-sized space that looks like an opening. It is located between the chest and lungs. The pleural cavity is a zone that plays a crucial role in the breathing process. It produces a small amount of fluid, which is necessary to reduce the rate of friction of the lungs against the chest from the inside.
Normally, up to 25 ml of this lubricant is released. Against the background of the course of any pathological process, fluid production increases. Due to this, the lung can not completely straighten out when inhaling.
The main indication for the purpose of the analysis is an inexplicable increase in the amount of pleural fluid in combination with increased body temperature, shortness of breath, pain in the chest, cough and chills. Based on the results of the study, the doctor can judge the cause of the pathological condition.
What allows you to identify
The accumulation of pleural fluid is a consequence of the course of many ailments. The main causes of effusion:
- Congestive heart failure.
- Cirrhosis of the liver.
- Atelectasis.
- Nephrotic syndrome.
- Myxedema.
- Adhesive form of pericarditis.
- The penetration of cerebrospinal fluid into the pleura after an injury or surgery.
- Displacement of the venous catheter (central).
- Duropleural fistula.
- Pneumonia.
- Tuberculosis.
- Malignant neoplasms.
- Blockage of a thrombus of a pulmonary artery.
- Systemic lupus erythematosus.
- Rheumatoid pleurisy.
- Pancreatitis
- Perforation of the esophagus.
- Fungal infection.
- Breakthrough lung abscess.
- Meigs Syndrome.
- Ovarian hyperstimulation during IVF.
- Asbestosis
- Severe renal failure of a chronic nature.
- Sarcoidosis
- Autoimmune pathologies.
- Abscess of the liver.
In the process of analyzing pleural effusion, a specialist can identify the above diseases, even at an early stage of their development.
Preparation
The decision on the appropriateness of a puncture is made by the attending physician based on the diagnostic results. If the analysis of pleural effusion is a necessity, the specialist must prepare the patient for the upcoming procedure.
First of all, the doctor directs the patient for examination, including:
- ECG.
- Roentgenography.
- Ultrasound
If the patient has a pronounced cough, the doctor prescribes him to take medications.
Immediately before the procedure, the nurse measures the pulse and pressure of the subject. In addition, a clinical blood test is performed. If the patient is unconscious, the procedure is carried out in the ward of the stadium. In other cases, it is carried out in a manipulation room.
Biomaterial sampling algorithm
Puncture of pleural fluid is a serious procedure that requires a doctor to have certain skills.
The algorithm of its implementation:
- The patient assumes a sitting position and rests his hands on the back of the chair. Less often, the patient fits on the couch and turns on a healthy side. In doing so, he should have his hand behind his head.
- A nurse measures pressure and pulse. She must follow the indicators throughout the procedure. If abnormalities are found, she needs to notify the doctor about this.
- A specialist examines an X-ray to determine the puncture site. With the accumulation of pathological effusion, the needle is inserted in the area 7-9 of the intercostal space along the axillary line behind. If the patient is in a prone position, the puncture site is somewhat shifted.
- The skin around the necessary area is covered with disposable sterile diapers. Then the puncture site is treated with alcohol or iodine solution.
- The doctor performs anesthesia. As a rule, a novocaine solution is used for pain relief. The needle is inserted along the upper part of the underlying rib. This minimizes the risk of damage to blood vessels and nerve fibers. The solution is injected gradually.
- With a disposable sterile needle, the doctor punctures the pleura. The patient at this time experiences a sharp pain. Pleural fluid enters the syringe by sipping a piston. With a large amount of effusion, an electric pump is used. In such cases, the needle is replaced with a thicker one.
- After pumping out the effusion, the doctor introduces an antimicrobial drug into the pleural cavity.
The final step is a sharp needle removal. The puncture site is then treated with iodine solution or medical alcohol. After that, a bandage is applied to it or a patch is glued.
Possible complications
It is important to know that puncture is associated with a certain risk. With the correct procedure, it is minimal.
In rare cases, complications develop that require immediate medical attention (including surgery). These include:
- Damage to the lung tissue, resulting in pneumothorax.
- Puncture of the stomach, diaphragm, liver or spleen. These conditions instantly disrupt the functioning of the heart and can lead to cardiac arrest.
- Violation of the integrity of blood vessels.
- Infection of the pleura or chest.
- Aerial embolism of the blood vessels of the brain.
- A sharp decrease in blood pressure.
If a patient develops a cough with blood, he suddenly turns pale, faints or has cramps, and the person is placed in the intensive care unit.
Macroscopic examination
This analysis of pleural fluid implies its assessment by nature, density, transparency and color.
Doctors divide the effusion into 2 large groups:
- Transudates. These are non-inflammatory fluids.
- Exudates. These are inflammatory effusions. They, in turn, can be serous, serous-fibrinous, hemorrhagic, chylous, chylose-like, pseudochylous, cholesterol, putrefactive.
Indicators of color and transparency of the pleural fluid in the lungs directly depend on its nature. Serous exudates and transudates, as a rule, have a light yellow tint. Moreover, they are transparent. Other types of exudates are cloudy and may have different colors.
The density of the liquid is determined by the urometer. In transudates, the indicator ranges from 1005-1015, in exudates - above 1015.
Chemical research
In the process of analysis, the protein content is determined using a refractometer. The indicator is measured in grams per liter. Transudates contain up to 25 g / l, exudates contain more than 30 g / l.
In order to differentiate liquids, a Rivalta test is performed. The essence of the method is the acidification of distilled water, followed by the addition of a few drops of effusion. Exudates during the chemical reaction form a turbidity resembling an externally white cloud. Its appearance is due to the presence in the liquid of seromucin, a substance that coagulates upon contact with acetic acid. Transudates do not possess such a property, that is, they do not form turbidity.
Microscopic analysis
This is a study of pleural fluid, in the process of which the cellular composition of the effusion is evaluated:
- Fatty drops. Peculiar to purulent and chylous exudates.
- Cholesterol crystals. Present in old effusions.
- Malignant cells.
- Red blood cells and white blood cells. Normally, they are present in all liquids. An increased number of red blood cells and white blood cells may indicate the presence of purulent and serous exudate.
- Mesothelial cells. If they have undergone changes and are found in the form of clusters, this indicates an old transudate.
Duration
Analysis of pleural fluid takes time. In most cases, the patient receives an opinion 3 working days after the collection of the biomaterial. In this case, the procedure itself takes no more than 30 minutes.
Interpretation of Results
Normal pleural effusion is transparent and has no color. The pH of the liquid is at least 7.6 and not more than 7.64. The protein content in the effusion should not exceed 2 g / l. The number of white blood cells is normal no more than 1000 mm 3 . The glucose indicator is the same as in the blood. The level of LDH is 2 times less than in liquid connective tissue.
Any deviations from the norm indicate violations:
- Red color of effusion - pulmonary infarction, asbestosis, trauma, malignant neoplasm, pleural endometriosis.
- Milky or white tint - metastasis of the tumor, lymphoma.
- Black color - the body is infected with aspergillus fungus.
- A greenish tint is the presence of a fistula between the gallbladder and the pleural cavity.
- Dark red or brown color - amoebiasis, rupture of a liver cyst.
- Viscous effusion - empyema, mesothelioma.
- A pH of less than 6 indicates damage to the esophagus.
- The pH level is 7-7.2 - pleurisy.
- PH 7.3 - empyema, tumor, systemic lupus erythematosus, tuberculosis, violation of the integrity of the walls of the esophagus. In addition, such an indicator often indicates pleurisy of a rheumatoid nature.
- A high level of LDH (1000 units or more) is a tumor of a malignant nature, empyema, pneumonia (usually against the background of AIDS), paragonimiasis.
- A glucose value of less than 1.6 mmol / L is rheumatoid pleurisy. Less commonly, empyema.
- Glucose level from 1.6 to 2.7 mmol / l - tumor, rupture of the esophagus, pleurisy against the background of systemic lupus erythematosus, tuberculosis.
- The presence of lactic acid indicates the active activity of bacteria.
- The presence of amylase in effusion is pancreatitis, a violation of the integrity of the walls of the esophagus, pseudocyst of the pancreas, necrosis of the small intestine, peptic ulcer.
- An increased level of neutrophils - empyema, diseases of an infectious nature.
- Increased red blood cell count - tumors, chest injuries, pulmonary infarction.
- Lymphocytes more than 85% - tuberculosis, sarcoidosis, lymphoma, chronic rheumatoid pleurisy, chylothorax, yellow nail syndrome.
- The presence of abnormal cells - tumor metastasis, mesothelioma, blood cancer.
- Lymphocytes not less than 50 and not more than 70% - the presence of malignant neoplasms.
- Eosinophils more than 10% - asbestosis, pulmonary embolism, diseases of a parasitic or fungal nature, a tumor.
Thus, using the analysis of pleural fluid, it is possible to identify the existing pathology at any stage of its development.
Where to turn in
The study of effusion is carried out both in state and commercial medical institutions. But the analysis is not carried out in all clinics. The institution should have a equipped laboratory, reagents, as well as highly qualified workers. Regarding the availability of this service, you must find out directly at the registry.
Cost
The price of pleural fluid analysis depends on the region and the policy of the medical institution. For example, the average cost of research in Moscow is 750 rubles. The necessary equipment and reagents in the capital are equipped with 23 laboratories. The lowest price in Moscow is 550 rubles, the highest is 950 rubles.
In addition, it is important to consider the cost of biomaterial sampling. The price is, on average, 250 rubles. In private institutions, a doctor’s consultation is additionally paid. The cost of initial admission varies from 1000 to 2500 rubles.
In the clinic at the place of residence, the analysis of pleural fluid (if this service is available) is carried out free of charge, you only need to present a medical insurance policy.
Finally
The study of effusion is shown with a sharp increase in its volume. Using the analysis of pleural fluid, the doctor is able to detect the presence of a pathological process even at an early stage of its development. The study does not imply the observance of strict training rules, the doctor and the nurse carry out all the necessary measures immediately before the procedure.
Puncture of effusion is associated with the occurrence of pain in the patient. In order to minimize them, the doctor introduces a person a solution of novocaine. After that, biomaterial is taken. The duration of the procedure is about half an hour.