Pleural effusion

Pleural effusion
Pleural effusion is an accumulation of fluid between the lung and the chest wall caused by different primary diseases. Inflammation of the pleura is wet always associated with Pleural effusion, which is a main symptom in diseases not directly affecting the lungs: malignancy, heart disease, kidney, liver and rheumatoid. In this case, the cause of effusion is determined by taking a sample (pleural puncture).

 
Definition

Acumualarea fluid between the lung and the chest is called pleural effusion. Normally the space between the visceral and parietal pleura there a movie about 15 ml of fluid. Of this amount, 10 ml of pluera resorbed and subsequently produced the same amount. Disruption of this balance leads to the formation of a pleural effusion, the accumulation of fluid in the lower chest (due to gravity force).

Anatomy

The lungs and chest cavity are lined internally by a thin layer, called the pleura, which has two parts: - Visceral pleura: a thin layer of tissue that covers the surface of both lungs; - Parietal pleura: a thin layer of tissue that lines the inside of the chest, upper diaphragm and pericardium;

If the lungs to expand normally, they foil the parietal are glued together by a liquid film lubrication role. Because of this, the lungs are very close to the chest wall, but with all these moves without friction during breathing movements. Parietal foils are so thin, that are not normally visible at chest radiography. However, pleura expands greatly and has a central position in the body, making it susceptible to damage in the evolution of many diseases.

 
Etiology

Plueral effusion manifests as the central symptom in various diseases, such as: Malignant neoplasms: bronchial carcinoma, breast carcinoma, ovarian carcinoma, malignant lymphoma, etc.. Inflammatory diseases: pneumonia, tuberculosis, pancreatitis, rheumatic diseases; Right heart failure; Changing composition of blood proteins (hypoalbuminemia) in liver cirrhosis and kidney disorders (nephrotic syndrome); The most frequent causes of pleural effusion is heart failure and pneumonia.

 
Clinical

Typical symptoms of Pleural effusion are: - Dyspnea; - Pain in breathing; - Chest tightness;
Pleural effusion can occur without pronounced symptoms without affecting the general condition of the patient.

 
Diagnosis

For diagnosis of pleural effusion is the patient's clinical examination: see carefully airways, lung auscultation and percussion is made, which can detect early signs of pleural effusion.

Diagnosis of certainty arises with modern methods of investigation: - Chest X-ray examination; - Ultrasound; - Computertomografie;

Pleural effusion Once diagnosed, it requires taking a sample of liquid emergency by pleural puncture with a needle guided by ultrasound. According to the analysis of fluid samples (protein content is investigating, weight, cell content - eg inflammatory or tumor cells) can determine the cause of effusion.

If this remains unclear, we recommend to a toracoscopii. This test involves inserting an optical device in the chest through a small incision. Previously expanding space is made between the two parietal foil (use gas) to facilitate entry of the endoscope, which can directly visualize and remove a sample of pleural fluid.

 
Treatment

Treatment of pleural effusion is based on primary disease.
General measures like respiratory gymnastics, and ionization pads help prevent complications and improve the general condition of the patient.

In the case of an extended or pleural effusion of primary disease can not be addressed with medication, treatment options there are the following:

Pleural puncture therapeutic purpose: it can significantly improve the patient suffering from severe dyspnea due to an extensive pleural effusion. As with pleural puncture for diagnostic, are removed from the chest with a needle, 500-1000 ml of fluid.

Chest Drainage: If you do not regress or Pleural effusion infected with bacterial pathogens, causing the accumulation of pus (pleural emphysema), we recommend to the length of the multi drainage by placing a Mandrel poured in, with a needle. The outer end Mandrel (which remain some days in your chest) will be drawn continuously through a valve, the pleural fluid. In case of infection can be done, all drained by this method, an antibiotic lavage.

Pleurodezia: If the primary condition that triggered Pleural effusion is not treatable, can be sticking to foil drug pleural drainage via chest still.

Toracoscopia therapy: If purulent bacterial infection cause massive accumulation or the formation of growths in the interpleural space, they can be removed with an endoscope. Further development of normal lung leads to rapid improvement of health of the patient.

 
Charts

Evolution of pleural effusion depends largely on the prognosis and treatment of primary disease.

If Pleural effusion is not removed, can form thin membranes, the fluid may solidify and dilatation due to its action, can lead to chronic respiratory disorders.

If Pleural effusion is caused by pneumonia, the risk of transmission of inflammation on pleural effusion. Pleural puncture showing a purulent discharge. Inflammatory symptoms, fever and fatigue is drastically worse. Purulent pleural effusion is called pleural emphysema. It can be caused by iatrogenic measures (hospital) - such as puncture or drainage - for whom we do not strictly comply with the rules of asepsis.

 
Prevention

Because Pleural effusion is usually due to other primary diseases, the only prophylactic measure is to consult a doctor if emergency breathing pains. Timely diagnosis and treatment of pleural effusion prevents serious forms of evolution.