The lungs are surrounded on all sides by dense connective tissue, which protects the respiratory organs, ensures their movement, as well as their expansion during inspiration. This is a kind of bag consisting of two leaves, between which there is always a small amount of liquid, so that the leaves constantly slide.
In some diseases, the volume of this fluid increases, and an effusion forms in the pleural cavity. There is a similar condition quite often. It does not apply to an independent disease, but only is a complication of the pathological process. Therefore, careful diagnosis and treatment is required.
Pleural cavity anatomy
The pleural cavity is presented in the form of a narrow gap in two asymmetric bags surrounding each lung. They are isolated from each other and have no contact with each other. Such bags are made of serous tissue and are a combination of inner and outer leaves.
Pleura lines the cavity of the chest and completely covers every lung. Its lateral part smoothly passes into the diaphragm. The transition points are called sines, and, basically, it is in them that fluid accumulates.
The negative pressure that is created in the pleural cavity allows the lungs to function, ensuring their position in the chest and normal work when inhaling and exhaling. If an injury occurs and the pleural gap is affected, then the pressure inside and outside is equalized, disrupting the functioning of the lungs.
The liquid contents of the pleural cavity are updated by its production by capillaries and removed through the lymphatic system. Since the pleural bags are isolated, the fluid from one cavity does not enter the adjacent one.
Possible diseases
Exudation in the pleural cavity is often formed during the course of inflammatory and non-inflammatory diseases. Among the contents that can accumulate, doctors distinguish:
- blood;
- transudate;
- chyle;
- exudate;
- pus.
Blood is formed as a result of trauma to the chest, in particular, vessels of the membranes of the pleura. If there is blood, doctors talk about hemothorax. This condition often occurs after operations in the sternum.
The chylus is formed in the case of chylothorax. It is a milky white lymph with a high lipid content. Chylothorax occurs as a result of a closed chest injury as a complication after surgery, during the course of tuberculosis, as well as oncological processes in the lungs. Often, it causes pleural effusion in newborns.
Transudate is an edematous fluid resulting from impaired lymph circulation and blood circulation. This can be in case of trauma, loss of blood, burns, with nephrotic syndrome.
Exudate is an inflammatory fluid that is formed by small blood vessels during inflammatory lung diseases.
With inflammation of the pleura, pus accumulates. It is also formed during the course of infectious and tumor processes, in case of a sternum injury.
Features of pleural effusion
It is an accumulation of fluid contents in the pleural cavity. This condition requires urgent intervention, as it poses a direct threat to human health and life.
Exudation in the pleural cavity is often diagnosed in people with lung diseases and heart failure. The cause may be transudate or exudate. The latter is formed as a result of the course of inflammatory diseases, viral and infectious lesions of the lungs, as well as tumors.
Main classification
It is very important to know exactly what pleurisy is, and what signs it is characterized. This is an accumulation of fluid in the pleural region, and the symptoms of this condition largely depend on its amount. If it is more than normal, then doctors talk about the exudative form of the disease, which mainly occurs at the very beginning of the pathology. Gradually, the fluid dissolves, and on the surface of the pleura leaves overlays of protein are formed that are involved in blood coagulation processes.
The composition of the liquid may be different. It is determined during pleural puncture. That is why the effusion can be:
- serous - a clear liquid;
- serous fibrinous - with impurities of fibrin;
- purulent - contains white blood cells;
- putrefactive - with particles of decayed tissue;
- chylous - contains fat;
- hemorrhagic - with impurities of blood.
The effusion in the pleural cavity can move freely or be limited between the leaves. Depending on the location of the pathological focus, there are:
- apical;
- costal;
- diaphragmatic;
- paramediastinal;
- mixed.
In addition, the effusion can be one-sided or both lungs are affected at once. Depending on this, the symptoms vary and treatment is selected.
Causes of occurrence
The causes of effusion in the pleural cavity are mainly associated with chest injuries or infection of the pleura. Often the accumulation of a large amount of fluid occurs during various diseases of the organs located in the chest and peritoneum or develops as a complication. Among the most common reasons, it is necessary to highlight such as:
- heart failure;
- tuberculosis, pneumonia, thromboembolism;
- cholecystitis, phlegmon of the neck, peritonitis, pancreatitis;
- metastasis of malignant tumors.
Free effusion in the pleural cavity is often observed in cancer of the ovaries, lungs and breast. If transudates act as provocateurs of the formation of an excessive amount of fluid, then the clinical course of the pathology does not require special diagnostic methods and treatment.
Risk factors
A small effusion in the pleural cavity accumulates due to the occurrence of pathological processes in the circulatory and lymphatic systems. These include violations such as increased production of certain substances and the lack of their elimination.
The main risk factor is the long stay of the patient in the hospital, which implies a constant bed rest. More than 10% of patients have fluid accumulation in the pleural cavity. In addition, the risk of effusion is manifested as complications in pathologies such as:
- prolonged impaired lung function;
- inflammatory processes;
- leukemia and mesothelioma;
- malignant neoplasms;
- postoperative condition;
- HIV infection.
Timely identification of the cause and correctly conducted treatment can provoke activation of an excessive increase in the amount of fluid in the pleural cavity.
Clinical manifestations
Symptoms of pleural effusion are not always manifested quite clearly and pronounced. Often, signs of pathology are determined during a diagnostic examination. Among the first signs, it is necessary to distinguish such as:
- dyspnea;
- sternal pain;
- detection of characteristic sounds when tapping;
- noise during breathing;
- dry cough.
It is also important to identify signs of pulmonary tuberculosis in the early stages, as this disease often leads to the accumulation of excessive amounts of fluid. The first symptom is the appearance of painful manifestations.
Diagnostics
The main principle for the diagnosis of effusion in the pleural cavity is to determine the type of accumulated substance. This becomes the main criterion for choosing a treatment method. Initially, the doctor examines the patient, and then prescribes a series of laboratory tests. This is a blood test, sputum and urine.
A study of sputum allows you to determine the presence of pathogens in the pleura and select the most effective treatment technique. More informative are instrumental techniques. Among them, it is necessary to highlight such as:
- chest x-ray;
- spirography;
- CT and MRI.
Using radiography, you can determine the location of the lesion and the level of fluid in the pleura. MRI and CT provide an opportunity to get a more accurate picture of the pathology, and are also a mandatory procedure during the operation. Spirography is performed to examine the bronchi, which allows to determine the peculiarity of the pathology and the degree of its spread. A significant role in the diagnosis is given to histological and cytological examination. They allow you to:
- differentiate the malignancy of the pathology;
- determine the cellular composition of the fluid;
- identify the shape and focus of the cancer;
- detect metastases.
Conducting histology and cytology gives the most complete description of the pathology, confirm or deny the presence of oncology.
Treatment features
It is important not only to know what pleurisy is, what exactly characterizes such a violation, and how treatment is carried out. Therapy largely depends on the cause of the pathology. With tuberculosis, the use of antimicrobials is required, and with a tumor, radiation or chemotherapy is required.
If a person has dry pleurisy, then symptomatology can be relieved by bandaging the chest with an elastic bandage. On the sore side, you can apply a small pillow to immobilize the irritated pleura.
In the presence of effusion in the pleural cavity, especially with a large amount, it is removed by pleural puncture. When taking liquid for analysis, the entire procedure is carried out very slowly so as not to provoke a sharp decrease in pressure.
Drug treatment
In the presence of effusion in the left pleural cavity, drug treatment is required. This is the most effective method of therapeutic effect, used to stop painful manifestations and stabilize the patient's condition. For the treatment prescribed antibacterial agents, analgesics.
With the growth of pathogenic microorganisms, a combined regimen is required with the use of “Cabapenems”, “Metronidazole” or “Clidamycin”. Of the antibacterial drugs that are introduced into the pleural cavity, Metronidazole, Penicillin, Ceftriaxone are used. A prerequisite is monitoring the patient throughout the course of therapy and monitoring the condition daily for six months.
Pleural cavity drainage
In the treatment of chronic effusion with frequent relapses, pleural cavity drainage is used. If the accumulation of fluid is negligible, then 1-2 aspirations are required daily. In the presence of a large amount of purulent effusion or its significant thickening, tubular siphon drainage is used.
After resection of the rib, the patient is shown open drainage for several months to remove accumulated exudate. Drainage is one of the best treatments. Sustainable drainage provides a full systematic removal of fluid with its constant accumulation.
Operation
If the signs of pulmonary tuberculosis in the early stages are recognized in a timely manner, then treatment can only be done with medication. In the event of complications or in the absence of positive dynamics, surgery may be required.
During the intervention, the accumulated fluid is pumped out of the pleural space. This method is considered the most effective.
Possible complications
Complications developing against a background of pleural effusion are diverse. Their manifestation largely depends on the course of the underlying disease.
If effusion in the pleural cavity began to accumulate due to pneumonia or tuberculosis, then complications may occur in the form of insufficient respiratory function or the occurrence of emphysema. In violation of cardiac activity, there may be instability of the heart rhythm and tachycardia. Excessive accumulation of effusion and complications can lead to death of the patient.
Prophylaxis
Prevention is important to prevent effusion. It is expressed in:
- timely treatment of pneumonia, infectious diseases of the respiratory system, as well as heart pathologies;
- balanced nutrition;
- refusal from smoking and consumption of alcoholic beverages;
- full sleep.
This will prevent the development of serious diseases, and if necessary provide a quick recovery.