The lungs are surrounded on all sides by dense connective tissue, which protects the respiratory organs, ensures their movement, as well as straightening during inspiration. This is a kind of bag consisting of two sheets, between which there is always a small amount of liquid, due to which the sheets constantly slide.
In some diseases, the volume of this fluid increases, and an effusion forms in the pleural cavity. This condition occurs quite often. It does not belong to an independent disease, but is only a complication of the pathological process. Therefore, careful diagnosis and treatment are required.
Anatomy of the pleural cavity
The pleural cavity is presented as a narrow slit in two asymmetrical sacs surrounding each lung. They are isolated from each other and do not touch each other in any way. Such bags consist of serous tissue and are a combination of inner and outer sheets.
The pleura lines the chest cavity and is completelycovers each lung. Its lateral part smoothly passes into the diaphragm. The transition points are called sinuses, 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 during inhalation and exhalation. If an injury occurs and the pleural gap is touched, then the pressure inside and outside is equalized, disrupting the functioning of the lungs.
The fluid content of the pleural cavity is renewed by its production by capillaries and removed through the lymphatic system. Since the pleural sacs are isolated, fluid from one cavity does not flow into the next one.
Possible diseases
Effusion in the pleural cavity is often formed during the course of inflammatory and non-inflammatory diseases. Among the contents that can accumulate, doctors highlight:
- blood;
- transudate;
- hilus;
- exudate;
- pus.
Blood is formed as a result of trauma to the chest, in particular, the vessels of the pleural membranes. In the presence of blood, doctors speak of hemothorax. This condition often occurs after surgery in the sternum.
Chylus is formed in 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, with the course of tuberculosis, as well as oncological processes in the lungs. It often causes pleural effusion innewborns.
Transudate is an edematous fluid formed as a result of impaired lymph circulation and blood circulation. This can be in case of trauma, blood loss, burns, nephrotic syndrome.
Exudate is an inflammatory fluid that is formed by small blood vessels during inflammatory lung diseases.
When the pleura becomes inflamed, pus accumulates. It is also formed during the course of infectious and tumor processes, in case of injury to the sternum.
Features of pleural effusion
It is an accumulation of liquid contents in the pleural cavity. Such a condition requires urgent intervention, as it poses a direct threat to human he alth and life.
Pleural effusion is often diagnosed in people with lung disease and heart failure. It can be caused by transudate or exudate. The latter is formed as a result 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 by. 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 liquid is absorbed, and protein deposits are formed on the surface of the pleura sheets, which are involved in the coagulation processes.blood.
The composition of the liquid may vary. It is determined during a pleural puncture. That is why the effusion can be:
- serous - clear liquid;
- serous-fibrinous - with impurities of fibrin;
- purulent - contains white blood cells;
- putrid - with pieces of decayed tissue;
- chile - contains fat;
- hemorrhagic - with blood impurities.
Effusion in the pleural cavity can move freely or be limited between sheets. Depending on the location of the pathological focus, they distinguish:
- apical;
- costal;
- diaphragmatic;
- paramediastinal;
- mixed.
In addition, the effusion can be unilateral or both lungs are affected at once. Depending on this, the symptoms differ and the treatment is selected.
Causes of occurrence
Causes of effusion in the pleural cavity are mainly associated with chest trauma or infection of the pleura. Often, the accumulation of a large amount of fluid occurs during the course of various diseases of the organs located in the chest and peritoneum or develops as a complication. Among the most common reasons, one should highlight such as:
- heart failure;
- tuberculosis, pneumonia, thromboembolism;
- cholecystitis, neck phlegmon, peritonitis, pancreatitis;
- Metastasis of malignant tumors.
Free pleural effusion oftenseen in ovarian, lung and breast cancer. If transudates act as provocateurs for the formation of an excessive amount of fluid, then the clinical course of the pathology does not require special methods of diagnosis and treatment.
Risk factors
A small effusion in the pleural cavity accumulates due to pathological processes in the circulatory and lymphatic systems. These include such violations as increased production of certain substances and insufficiency of their excretion.
The main risk factor is the long stay of the patient in the hospital, which involves constant bed rest. More than 10% of patients experience fluid accumulation in the pleural cavity. In addition, the risk of effusion appears as complications in pathologies such as:
- prolonged lung dysfunction;
- inflammatory processes;
- leukemia and mesothelioma;
- malignant neoplasms;
- postoperative condition;
- HIV infection.
Timely identification of the cause and proper treatment can provoke the activation of an excessive increase in the amount of fluid in the pleural cavity.
Clinical manifestations
Symptoms of pleural effusion are not always quite bright and pronounced. Often, signs of pathology are determined during a diagnostic examination. Among the first signs, it is necessary to highlight such as:
- shortness of breath;
- chest pain;
- detectioncharacteristic sounds when tapping;
- breathing noises;
- dry cough.
It is also very 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 basic principle of diagnosing 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 patient is examined by a doctor, and then a series of laboratory tests is prescribed. This is a blood, sputum and urine test.
Sputum examination allows you to determine the presence of pathogens in the pleura and choose the most effective method of therapy. Instrumental methods are considered more informative. Among them, it is necessary to highlight such as:
- chest x-ray;
- spirography;
- CT and MRI.
Using x-rays, you can determine the location of the lesion and the level of fluid in the pleura. MRI and CT make it possible to obtain a more accurate picture of the course of the pathology, and are also a mandatory procedure during the operation. Spirography is performed for the purpose of examining the bronchi, which allows to determine the features of the pathology and the degree of its spread. A significant role in the diagnosis is given to histological and cytological examination. They allow:
- differentiate the malignancy of pathology;
- determine the cellular composition of the fluid;
- detect the shape and focus of a cancerous tumor;
- detect metastases.
Carrying out histology and cytology gives the most complete description of the pathology, confirm or refute the presence of oncology.
Features of treatment
It is important not only to know what pleurisy is, what exactly characterizes such a violation and how it is treated. Therapy largely depends on the cause of the pathology. Tuberculosis requires antimicrobials, while tumors require radiation or chemotherapy.
If a person has dry pleurisy, then the symptoms can be alleviated by bandaging the chest with an elastic bandage. A small pillow can be applied to the affected side to immobilize the irritated pleura.
If there is an effusion in the pleural cavity, especially if there is a large amount, it is removed by pleural puncture. When taking a liquid for analysis, the entire procedure is carried out very slowly so as not to provoke a sharp decrease in pressure.
Medicated treatment
If there is an effusion in the left pleural cavity, medical treatment is required. This is the most effective method of therapeutic action, used to relieve painful manifestations and stabilize the patient's condition. For therapy, antibacterial agents and analgesics are prescribed.
With the growth of pathogenic microorganisms, it is requiredcombined scheme with the use of Kabapenem, Metronidazole or Clidamycin. Of the antibacterial drugs that are introduced into the pleural cavity, Metronidazole, Penicillin, Ceftriaxone are used. A prerequisite is to monitor the patient throughout the course of therapy and monitor the condition daily for six months.
Drainage of the pleural cavity
In the treatment of chronic effusions with frequent recurrences, pleural cavity drainage is used. If the accumulation of fluid is insignificant, then 1-2 aspirations daily are required. In the presence of a large amount of purulent effusion or its significant thickening, tubular siphon drainage is used.
After rib resection, the patient is shown open drainage for several months to remove accumulated exudate. Drainage is one of the best methods of treatment. Steady drainage ensures the full systematic removal of fluid with its constant accumulation.
Operating
If signs of pulmonary tuberculosis are recognized in time in the early stages, then treatment can only be carried out with medication. In case of complications or in the absence of positive dynamics, an operation 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 that develop against the background of the flow of pleural effusion are diverse. Their manifestationlargely 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 respiratory failure or 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
Prophylaxis is important to prevent effusion. It is expressed in:
- timely treatment of pneumonia, respiratory infections, and heart pathologies;
- balanced diet;
- to stop smoking and drinking alcohol;
- good sleep.
This will prevent the development of serious diseases, and, if necessary, will ensure a quick recovery.
