Pleural effusion

Pleural effusion is a term used in medicine and referred to an abnormal accumulation of fluid in the pleural cavity, the narrow gap between the Pleurablättern. This liquid is thus located in the chest between the lungs and the ribs, more strictly between the pulmonary pleura ( visceral pleura ) and the breast, or pleura ( parietal pleura ). Here it is, simply put, to " fluid around the lung "; the colloquial term " water in the lungs " refers mostly to the clinical picture of pulmonary edema associated with heart failure.

Even in healthy people, the pleural cavities are filled with about 5 ml of a protein-rich fluid, which gives the lungs as a sliding layer freedom of movement when inhaling and exhaling.

Classification and Causes

Pleural effusions are divided into low-protein transudates and exudates rich in protein, continue to the effusion can bloody, purulent or milchigtrüb be. It can either be free around the lung " leak " or " chambered " by adhesions. In young patients, the cause is often TBC.

Possible causes of pleural effusion are:

• Oncotically hydrostatic, due to the pressure and thus the liquid filtration, for example: in the context of heart failure ( one of the most common causes of pleural effusion )
• Constrictive pericarditis
• Hypoalbuminemia
• Hydronephrosis

• Tuberculosis
• Viruses and mycoplasma
• Fungi and parasites
• Parapneumonisch (bacterial pneumococcal pneumonia in the context )
• As nonspecific empyema ( pus )

• Mesothelioma, a malignant ( carcinomatosis ) tumor cell colonization of the pleura

• Collaterals in cirrhosis

• After rib fracture
• Postoperative
• By lymph ( chylothorax )

In severe hemorrhage is a hemothorax.

Symptoms

Minor bruising to about 500 ml are often not noticed. For larger effusion occurs as a symptom of breathlessness, the first already occurs during physical exertion, with increasing effusion alone. Cough is common in larger effusions, respiratory -related chest pain can occur in a simultaneous inflammation of the pleural surfaces. However, they are in large effusions rather the exception.

Diagnostics

One can assume an effusion in a damping of the knocking sound and a weakening of the respiratory sound, and the vocal fremitus over a section of the lung. Evidence, it can be the fastest and most accurate by an ultrasound.

On the chest X-ray pleural effusions are usually recognizable from a volume of 250-300 ml. It is typical for a custom built standing up recording a laterally ( outside) increasing shading ( Damoiseau -Ellis - line).

To clarify the cause of an effusion, it must often be dotted with effusion laboratory tests, are examined bacteriologically and cytologically.

For example, pleural effusions can transudates occur by heart failure, cirrhosis or active pleural exudates in (eg pleural mesothelioma ). The differentiation between a transudate and exudate the Light criteria help. In completing one or more of the following criteria is called an exudate:

Therapy

A small pleural effusion is often only a symptom and not itself require therapy. For larger pleural effusions ( > 1 liter) is often performed a therapeutic relief by means of thoracentesis. If it is a stronger effusion, a chest tube is usually performed. Can not all the liquid through this chest tube escape (this is by radiological examinations to check ), surgery may be necessary as part of the effusion can encapsulate. This is done minimally invasive and leaves no scars today. With constantly trailing effusions may need a chemical or surgical pleurodesis. The goal of both procedures is a scarring of the pleura, so that no renewed effusion may accumulate between them. In chemical pleurodesis a pro-inflammatory fluid (eg Tetracycline / doxycycline) is temporarily introduced into the pleural space via a chest tube. Wanted consequence of the inflammatory response is the scarring of the pleural membranes. In the surgical pleurodesis the inflammatory stimulus is a minimally invasive set mechanically, eg by roughening of the pleural under thoracoscopic control ( " keyhole surgery "). Both methods require a chest tube, which must remain lying until no or only runs a minimal effusion. A longer hospital stay must therefore be taken into account, with every fourth patient, the scarring of the pleura does not work ( 1). An alternative can be the application of a drainage tube, which can be left for a long period in the chest. A thin drainage tube with valve mechanism ( indwelling catheter ) can be placed on an outpatient basis under local anesthesia in the pleura. Every day, the patient himself or the Nursing connect the hose to a vacuum bottle and to drain to one liter effusion. This allows the patient to receive home their mobility, and in the majority of patients experience after a month in the spontaneous adhesion of the pleural membranes (2, 3), and the silicone tube can be removed.