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 quite dangerous. Pathology is diagnosed in various ways, after which the doctor prescribes the appropriate treatment.
In some cases, the accumulation of such fluid can provoke decompensation of respiratory failure, often leading to death. In addition, this disease is accompanied by very serious complications. Therefore, the treatment of such a pathology must be started as soon as possible.
General information
The human lungs are surrounded by two membranes called pleurae. The outer one attaches to the chest wall, and the inner one attaches to the lung and other tissues. A gap is formed between them, called the pleural cavity or cavity.
The free fluid in the pleural cavity acts as a lubricantcomponent of the pleural surfaces, allowing the layers to slide freely against each other during breathing. It also promotes surface tension, which keeps the surface of the lung in contact 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 any disease, then its volume can reach 5-6 liters.
The fluid accumulated in the pleural cavity can be different:
- blood if pleural vessels are damaged;
- non-inflammatory fluid (transudate);
- pus or fluid caused by inflammation of the pleura (exudate).
The accumulation of blood usually occurs as a result of damage to blood vessels, which occurs with injuries. Lymph enters the pleural cavity when the thoracic duct, which is the main lymphatic vessel, is injured.
Transudate can accumulate in any cavity if the body is systematically exposed to any systemic process. For example, it may be a decrease in blood pressure due to massive blood loss or a burn. Also, the presence of transudate in the pleural cavity is observed if hydrostatic pressure increases in the vessels, which happens with heart failure.
Fluid in the pleural cavity, in particular exudate, accumulates during the inflammatory process. It could be pneumonia, cancer, pleurisy.
Reasons
Fluid accumulated in the pleural cavity is a violation,which is secondary. 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, as a result of which the blood vessels located between the ribs are torn. The thoracic duct may also rupture.
- Inflammatory diseases of the abdominal organs. Exudate begins to accumulate in response to liver abscess, pancreatitis, subphrenic abscess, peritonitis.
- Oncological diseases affect the pleura not only as a primary focus, but also in the formation of metastases. Primary tumors arise from mesothelial cells and occur in people working in asbestos factories. The prognosis in this case is unfavorable. If the neoplasm is benign, the prognosis is usually good.
- Heart failure, which contributes to high 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 swelling) due to underactive thyroid.
- Pulmonary artery embolism syndrome, when a lung infarction occurs, followed by accumulationtransudate.
- Uremia due to kidney failure. This condition is typical for multiple organ failure, glomerulonephritis, sepsis, massive hemolysis of red blood cells, radiation sickness.
- Systemic connective tissue diseases: periarteritis nodosa, systemic lupus erythematosus, which are the cause of exudate accumulation.
Symptoms
Regardless of why fluid has accumulated in the pleural cavity, respiratory failure may occur. It appears as follows:
- pain on the left or right side;
- shortness of breath, shortness of breath;
- dry cough that occurs due to squeezing the bronchi with a large volume of fluid;
- limbs turn bluish due to lack of oxygen;
- increase in body temperature due to inflammation.
Let's consider in more detail the symptoms that indicate the accumulation of fluid in the pleural cavity in some diseases.
Injury
Injury 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 disturbance of consciousness, the skin becomes bluish, the person may fall into a coma.
When the thoracic aorta ruptures, blood begins to flow into the pleural cavity, which leads to large blood loss and hemorrhagic shock. Saving a person is almost impossible.
Cancer
When mesothelioma occurs, the presence of fluid in the pleural cavity is the final stage in the development of the neoplasm. It can be said with great certainty that death will occur in 7-10 months. The fluid with this disease is characterized by a sharp decrease in the level of 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 is taking place in the lung parenchyma:
- increased body temperature;
- wet cough;
- periodic side pain;
- shortness of breath;
- wet rales;
- severe intoxication of the body.
Heart failure
Fluid accumulated in the pleural cavity during heart failure manifests itself as follows:
- weakness;
- fatigue;
- heart starts to work intermittently;
- lack of desire for physical activity;
- chest pains.
Diagnosis
The most informative diagnostic method is chest x-ray, which helps to 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 prescribing the right treatment. The X-ray image accurately determines the level of the liquid and its approximate volume, the presence and absence of air.
It is also necessary to determine the nature of the effusion, and for this purpose, a puncture is performed. To do this, the contents of the fluid from the pleural cavity are taken to determine the ratio of the amount of protein, specific gravity, lactate dehydrogenase activity. Sowing on fungi, microorganisms, acid-resistant microbes is carried out. The fluid can be bloody, purulent, serous. The accumulation of blood exudate is observed in injuries, pulmonary infarction, oncological diseases with damage to the pleura. Purulent exudate accumulates in heart failure, and serous exudate after an infectious disease.
Computed tomography is also considered a good method for imaging the lungs and chest. Its advantage lies in the fact that the procedure allows you to accurately determine the amount of fluid released and the cause of this condition. Pulmonologists recommend having a CT scan once every six months. This allows identification of the fluid accumulation syndrome 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 removed by puncture, when a catheter or small needle is inserted into the pleural cavity. Usually a puncture is performed for diagnostic purposes, but during such a procedure it is possible to pump out up to 1.5 liters of effusion. No further removal is recommended as there is a risk of developing pulmonary edema.
Forto remove the accumulated fluid in a large amount, a tube is inserted into the chest through its wall. This 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 the fluid in the pleural cavity has accumulated due to tuberculosis or coccidioidomycosis, then long-term antibiotic treatment is required. Drainage is more difficult with highly viscous pus or when it is in a fibrous "pocket", so the situation can only be corrected by removing part of the rib to insert a large drainage catheter. Rarely, surgery is needed to remove the outer layer of the pleura.
Swelling of the pleura also leads to the fact that fluid begins to accumulate in the pleural cavity. Treatment in this case will be quite long, since it can be difficult to eliminate the effusion due to its rapid accumulation. Drainage and administration of anticancer drugs come 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 the effusion is removed through the tube, after which an irritating substance, such as talc or doxycycline solution, is injected into the pleural cavity through it. With the help of such an irritant, two layers of the pleura are fused, and forthere is no free space left 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 up blood clots. Continuous bleeding or inability to remove fluid through the catheter is an indication for surgery.
Complications
The fluid accumulated in the pleural cavity, especially in large quantities, can lead to many complications. It can be acute pulmonary insufficiency, inflammation and infection of a 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, complications from the gastrointestinal tract should be expected. This type of effusion, accumulated in the pleura, is a factor that often leads to death or disability. This concerns the need to resect 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, proceed to additional steps. It may be a rejection of harmfulhabits, maintaining a he althy lifestyle, taking vitamin complexes, as well as drugs saturated with useful components.
Preventive measures must necessarily include physical activity and a special diet. It is necessary to consume daily as many seasonal fruits and vegetables as possible, natural proteins, carbohydrates, fats, meat. Doctors recommend doing exercises every day, hardening and walking a lot. This approach to disease prevention is 100% effective.
Conclusion
So what to do if fluid is detected in the pleural cavity? The cause of 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 the appropriate and competent treatment. In order to prevent the development of pathology, it is necessary to adhere to preventive measures.
