What to do if the fluid in the pleural cavity: causes and treatment

If the liquid begins to accumulate in the pleural region (effusion), then such a serious pathological condition may indicate that a disease develops in the body, and is quite dangerous. The pathology is diagnosed in various ways, after which the doctor prescribes appropriate treatment.

In some cases, the accumulation of such a liquid can provoke a decompensation of respiratory failure, often leading to a fatal outcome. In addition, this ailment is accompanied by very serious complications. Therefore, the treatment of such a pathology must begin as soon as possible.

general information

Human lungs are surrounded by two membranes, called pleura. External connects to the wall of the chest, and the inner - to the lung and other tissues. Between them a gap is formed, called the pleural cavity or hollow.

Free fluid in the pleural cavity acts as a lubricating component of the pleural surfaces, allowing the layers to slide freely against each other during breathing. This also contributes to the surface tension, which allows you to keep the surface of the lung together with the wall of the chest. The amount of fluid in the pleural cavity should be 4 teaspoons. If it starts to accumulate as a result of the development of a disease, its volume can reach 5-6 liters.

The fluid accumulated in the pleural cavity may be different:

• Blood, if the vessels of the pleura are damaged;
• Non-inflammatory fluid (transudate);
• Pus or liquid, arising from inflammation of the pleura (exudate).

The accumulation of blood usually occurs as a result of damage to the blood vessels, which happens with injuries. Lymph penetrates into the cavity of the pleura when traumatizing the thoracic duct, which is the main lymphatic vessel.

The transudate can accumulate in any cavity in the event that the organism is systematically exposed to any systemic process. For example, it can be a reduction in blood pressure due to massive blood loss or burns. Also, the presence of transudate in the pleural cavity is observed if the hydrostatic pressure in the vessels increases , which is the case with heart failure.

Fluid in the pleural cavity, in particular exudate, accumulates in the inflammatory process. It can be pneumonia, cancer, pleurisy.

Causes

The fluid that accumulates in the pleural cavity is a disorder that is secondary in nature. This means that the development of pathology occurs against the background of a different disease in the body.

Which one? On what to sin if the fluid in the pleural cavity accumulated? The reasons can be as follows:

• Trauma of the chest, resulting in ruptured blood vessels located between the ribs. There may also be a rupture of the thoracic duct.
• Diseases of the abdominal cavity, which are inflammatory. Exudate begins to accumulate in response to liver abscess, pancreatitis, sub-diaphragmatic abscess, peritonitis.
• Oncological diseases affect the pleura not only as a primary focus, but also in the formation of metastases. Primary tumors originate from mesothelium cells and are found in people working in asbestos plants. The outlook is unfavorable in this case. If such a neoplasm is benign, the prognosis, as a rule, can be reassuring.
• Heart failure, which helps increase blood pressure.
• Pneumonia. Inflammatory process can proceed both in the depth of the lung parenchyma, and close enough from the pleura, which provokes the accumulation of inflammatory fluid.
• Infectious and allergic diseases.
• Tuberculosis.
• Myxedema (mucus edema), which occurs due to insufficient functioning of the thyroid gland.
• Syndrome of embolism of the arteries of the lungs, when there is a formation of a lung infarction with the subsequent accumulation of transudate.
• Uremia, which occurs with kidney failure. This condition is typical for multi-organ failure, glomerulonephritis, sepsis, massive hemolysis of erythrocytes, radiation sickness.
• Systemic diseases of connective tissue: nodular periarteritis, systemic lupus erythematosus, which are the cause of accumulation of exudate.

Symptoms

Regardless of why the accumulation of fluid in the pleural cavity occurred, 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 the squeezing of the bronchi with a large volume of fluid;
• Limbs acquire a bluish tint due to lack of oxygen;
• Increased body temperature due to the inflammatory process.

Consider in more detail the symptoms that indicate the accumulation of fluid in the pleural cavity for some diseases.

Injury

Trauma of the chest or lung leads to rapid development of respiratory failure. At the same time hemoptysis occurs, from the mouth appears a foamy phlegm sputum. There is a violation of consciousness, the skin acquires a cyanotic shade, a person can fall into a coma.

With rupture of the thoracic part of the aorta, the blood begins to flow into the cavity of the pleura, which leads to large blood loss and hemorrhagic shock. It is practically impossible to save a person.

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 with great certainty that the lethal outcome will come in 7-10 months. The fluid in 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 in the lung parenchyma the pathological process proceeds:

• Increased body temperature;
• Wet cough;
• Periodic pain in the side;
• dyspnea;
• Wet rales;
• Strong intoxication of the body.

Heart failure

The fluid accumulated in the pleural cavity with heart failure manifests itself as follows:

• weakness;
• fast fatiguability;
• The heart begins to work with interruptions;
• Lack of desire for physical activity;
• Chest pains.

Diagnostics

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 with the appointment of the right treatment. The X-ray pattern accurately sets the fluid 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. To do this, the contents of the fluid from the pleural cavity are taken to reveal the ratio of the amount of protein, the specific gravity, the activity of lactate dehydrogenase. Carry out sowing on fungi, microorganisms, acid-fast microbes. The fluid can be bloody, purulent, serous. Accumulation of blood exudate is observed in traumas, lung infarction, oncological diseases with pleural lesions. Purulent exudate accumulates in heart failure, and serous exudate accumulates after an infectious disease.

Computer tomography is also a good method of visualizing 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 conducting a computer tomography once every six months. This allows us to identify the syndrome of fluid accumulation in the pleural cavity.

Treatment

With a small 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 a small needle is inserted into the pleural cavity. Usually the puncture is performed for diagnostic purposes, but during this procedure it is possible to pump out up to 1.5 l of effusion. It is not recommended to remove it any more, as there is a risk of developing pulmonary edema.

To remove accumulated in a large amount of fluid in the chest, a tube is inserted through its wall. The procedure is as follows: after anesthesia, the doctor cuts and inserts a plastic tube between the two ribs of the chest. After that, he connects it to the drainage system, which does not allow air to enter the pleural cavity. With the help of X-ray control specialist specifies the correct installation of the tube, as otherwise drainage is impossible.

If fluid in the pleural cavity accumulated due to tuberculosis or coccidioidomycosis, then in this case, long-term treatment with antibiotics is required. Drainage is more difficult to perform with strongly viscous pus or when it is in a fibrous "pocket", so the situation can be corrected only by removing a part of the rib for the introduction of a large drainage catheter. Rarely an operation is required in order to remove the outer layer of the pleura.

Tumors of the pleura also lead to the accumulation of fluid in the pleural cavity. Treatment in this case will be quite long, since it is difficult to eliminate effusion because of its rapid accumulation. The drainage and administration of antitumor drugs comes to the rescue. But if such methods do not work, and the liquid continues to accumulate, the pleural cavity is isolated. The entire volume of effusion is removed through the tube, after which an irritant, for example, talc or a doxycycline solution, is introduced into the pleural cavity. With the help of such an irritant, two layers of the pleura coalesce, and there is no free space for the accumulation of fluid.

If the pleural cavity is filled with blood, then until bleeding has ceased, drainage is carried out through the tube, which is also used to administer drugs that cleave thrombi. Continuous bleeding or the inability to remove fluid through the catheter is an indication for prompt intervention.

Complications

The accumulated fluid in the pleural cavity, especially in large quantities, can lead to a variety of complications. It can be acute pulmonary insufficiency, inflammation and infection of mild genesis, problems with the function of the liver, heart and other internal organs.

Since fluid and pus have a high probability of spreading in the abdominal cavity, it is necessary to expect the development of complications from the gastrointestinal tract. This type of effusion, accumulated in the pleura, is a factor that often leads to death or disability. This concerns the need for resection of a part of the pancreas or spleen.

Such complications can occur both in men and women of any age, so treatment should be started as early as possible and preventive measures 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 has been successful, proceed to additional actions. This can be a rejection of bad habits, the maintenance of a healthy lifestyle, the intake of vitamin complexes, as well as saturated with useful components of drugs.

Preventive measures must necessarily include compliance with physical activity and a special diet. It is necessary to eat every day as much as possible seasonal fruits and vegetables, natural proteins, carbohydrates, fats, meat. Doctors recommend doing every day exercises, hardening and walking a lot on foot. This approach to disease prevention is 100% effective.

Conclusion

So what if there is a fluid 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 conducting diagnostic activities, will appoint appropriate and competent treatment. In order to prevent the development of pathology, it is necessary to adhere to preventive measures.