If fluid (effusion) begins to accumulate in the pleural region, then such a serious pathological condition may indicate that some kind of disease is developing in the body, and it’s quite dangerous. The pathology is diagnosed in various ways, after which the doctor prescribes the appropriate treatment.
In some cases, the accumulation of such a liquid can provoke decompensation of respiratory failure, often leading to death. In addition, this ailment is accompanied by very serious complications. Therefore, the treatment of such a pathology should be started as soon as possible.
general information
The human lungs are surrounded by two membranes called pleura. The outer joins the chest wall, while the inner joins the lung and other tissues. Between them forms a gap called the pleural cavity or cavity.
Free fluid in the pleural cavity acts as a lubricating component of the pleural surfaces, allowing the layers to glide freely against each other during breathing. It also contributes to the surface tension, which allows you to hold the surface of the lung together with the chest wall. The amount of fluid in the pleural cavity should be 4 teaspoons. If it begins to accumulate as a result of the development of a disease, then its volume can reach 5-6 liters.
The fluid accumulated in the pleural cavity can be different:
- blood, if the vessels of the pleura are damaged;
- non-inflammatory fluid (transudate);
- pus or fluid resulting from inflammation of the pleura (exudate).
Accumulation of blood usually occurs as a result of damage to blood vessels, which happens with injuries. Lymph penetrates the pleural cavity when injuring the chest duct, which is the main lymphatic vessel.
Transudate can accumulate in any cavity if the body is systematically subjected to any systemic process. For example, it may be a decrease in blood pressure due to massive blood loss or burns. Also, the presence of transudate in the pleural cavity is observed if hydrostatic pressure rises in the vessels , which happens with heart failure.
Fluid in the pleural cavity, in particular exudate, accumulates during the inflammatory process. It can be pneumonia, cancer, pleurisy.
Causes
Fluid accumulated in the pleural cavity is a disorder that is secondary in nature. This means that the development of pathology occurs against the background of another disease occurring in the body.
Which one? What to sin if fluid has accumulated in the pleural cavity? The reasons may be as follows:
- Injury to the chest, resulting in the rupture of blood vessels located between the ribs. A rupture of the thoracic duct may also occur.
- Inflammatory diseases of the abdominal cavity. Exudate begins to accumulate in response to a liver abscess, pancreatitis, subphrenic abscess, peritonitis.
- Oncological diseases affect the pleura not only as the primary focus, but also with the formation of metastases. Primary tumors arise from mesothelial cells and are found in people working in asbestos plants. The prognosis in this case is unfavorable. If such a neoplasm is benign, the prognosis, as a rule, can be encouraging.
- Heart failure, which contributes to an increase in blood pressure.
- Pneumonia. The inflammatory process can occur both deep in the lung parenchyma and close enough to the pleura, which provokes the accumulation of inflammatory fluid.
- Infectious and allergic diseases.
- Tuberculosis.
- Myxedema (mucosal edema), resulting from insufficient functioning of the thyroid gland.
- Pulmonary embolism syndrome, when the formation of pulmonary infarction occurs with subsequent accumulation of transudate.
- Uremia arising from renal failure. This condition is characteristic of multiple organ failure, glomerulonephritis, sepsis, massive hemolysis of red blood cells, radiation sickness.
- Systemic diseases of the connective tissue: periarteritis nodosa, systemic lupus erythematosus, which cause the accumulation of exudate.
Symptoms
Regardless of why fluid has accumulated in the pleural cavity, respiratory failure can occur. It manifests itself as follows:
- pain on the left or right side;
- shortness of breath, lack of air;
- dry cough, which occurs due to compression of the bronchi with a large volume of fluid;
- limbs become bluish due to lack of oxygen;
- an increase in body temperature due to the inflammatory process.
Let us consider in more detail the symptoms that indicate accumulation of fluid in the pleural cavity in some diseases.
Injury
Trauma to the chest or lungs leads to the rapid development of respiratory failure. In this case, hemoptysis occurs, foamy sputum of scarlet color appears from the mouth. There is a violation of consciousness, the skin acquires a bluish tint, a person can fall into a coma.
With a rupture of the thoracic aorta, blood begins to flow into the pleural cavity, which leads to large blood loss and hemorrhagic shock. To save a person is almost impossible.
Oncological diseases
When mesothelioma occurs, the presence of fluid in the pleural cavity is the final stage in the development of the neoplasm. It can be stated with great confidence that a fatal outcome will occur in 7-10 months. The fluid in this disease is characterized by a sharp decrease in glucose in it, viscosity due to hyaluronic acid, and most often it is bloody.
Pneumonia
The following symptoms of pneumonia will indicate that a pathological process occurs in the lung parenchyma:
- increase in body temperature;
- wet cough;
- periodic pain in the side;
- dyspnea;
- wet rales;
- severe intoxication of the body.
Heart failure
The accumulated fluid in the pleural cavity in heart failure manifests itself as follows:
- weakness;
- fast fatiguability;
- the heart begins to work intermittently;
- lack of desire for physical activity;
- chest pains.
Diagnostics
The most informative diagnostic method is chest x-ray, which helps confirm the presence of a pathology such as fluid syndrome in the pleural cavity, or its absence. This greatly facilitates the task of the doctor in the appointment of the correct treatment. An X-ray diffraction pattern accurately sets the liquid level and its approximate volume, presence and absence of air.
It is also necessary to determine the nature of the effusion, and for this purpose a puncture is performed. For this, the contents of the fluid from the pleural cavity are taken to reveal the ratio of the amount of protein, specific gravity, lactate dehydrogenase activity. Sow on fungi, microorganisms, acid-resistant microbes. The fluid may be bloody, purulent, serous. The accumulation of blood exudate is observed with injuries, pulmonary infarction, cancer with pleural involvement. Purulent exudate accumulates in heart failure, and serous exudate after an infectious disease.
Also, computed tomography is considered a good method for visualizing lungs and chest. Its advantage is that the procedure allows you to accurately determine the amount of fluid released and the cause of this condition. Pulmonologists recommend computed tomography once every six months. This allows you to identify the syndrome of fluid accumulation in the pleural cavity.
Treatment
With a slight accumulation of fluid, only the underlying disease is treated. A large amount of effusion, especially if it provokes shortness of breath, requires drainage to eliminate this ailment. Often, fluid is excreted by puncture when a catheter or small needle is inserted into the pleural cavity. Typically, a puncture is performed for diagnostic purposes, but during this procedure it is possible to pump out up to 1.5 liters of effusion. More removal is not recommended, as there is a risk of developing pulmonary edema.
To remove the fluid that has accumulated in large quantities, a tube is inserted into the chest through its wall. Such a procedure is carried out as follows: after anesthesia, the doctor makes an incision and inserts a plastic tube between the two ribs of the chest. After that, he connects it to the drainage system, which prevents air from entering the pleural cavity. With the help of x-ray control, the specialist clarifies the correct installation of the tube, since otherwise drainage is impossible.
If fluid in the pleural cavity has accumulated due to tuberculosis or coccidioidomycosis, then prolonged antibiotic treatment is required. Drainage is more difficult to carry out with highly viscous pus or when it is in a fibrous “pocket”, so the situation can be corrected only by removing part of the rib to insert a large drainage catheter. Surgery is rarely required in order to remove the outer layer of the pleura.
The tumor of the pleura also leads to the fact that fluid begins to accumulate in the pleural cavity. The treatment in this case will be quite lengthy, since eliminating the effusion can be difficult due to its rapid accumulation. The drainage and administration of anticancer drugs comes to the rescue. But if such methods do not bring results, and the fluid continues to accumulate, the pleural cavity is isolated. The entire volume of effusion is removed through the tube, after which an irritating substance, for example, talc or a solution of doxycycline, is introduced into the pleural cavity through it. With the help of such an irritant, two layers of the pleura are fused, and there is no free space for fluid accumulation.
If the pleural cavity is filled with blood, then until the bleeding has stopped, drainage is carried out through a tube, which is also used to administer drugs that break down blood clots. Continuous bleeding or the inability to remove fluid through a catheter is an indication for surgery.
Complications
Fluid accumulated in the pleural cavity, especially in large quantities, can lead to many complications. This can be acute pulmonary failure, inflammation and infection of the lung genesis, problems with the function of the liver, heart and other internal organs.
Since fluid and pus are highly likely to spread in the abdominal cavity, gastrointestinal complications should be expected to develop. This type of effusion accumulated in the pleural region is a factor that often leads to death or disability. This concerns the need for resection of part of the pancreas or spleen.
Such complications can occur in both men and women of any age, so treatment should be started as early as possible and preventive measures should be used.
Prevention
To avoid the occurrence of diseases that can cause accumulation of fluid in the pleural cavity, it is necessary to treat them in a timely manner. If antibiotic therapy or surgery is successful, they proceed to additional actions. This can be a rejection of bad habits, maintaining a healthy lifestyle, taking vitamin complexes, as well as saturated with useful components of drugs.
Preventive measures must necessarily include adherence to physical activity and a special diet. It is necessary to eat daily as much as possible seasonal fruits and vegetables, natural proteins, carbohydrates, fats, meat. Doctors recommend doing exercises every day, hardening and walking a lot on foot. This approach to disease prevention is 100% effective.
Output
So what if fluid is detected in the pleural cavity? The reason for this pathological condition is the development of the disease, most often quite serious. In some cases, the resulting disease can lead to death. Be sure to contact a specialist who, after carrying out diagnostic measures, will prescribe an appropriate and competent treatment. In order to prevent the development of pathology, it is necessary to adhere to preventive measures.