Pleurisy — excessive accumulation of fluid in the pleural cavity can occur in any disease, but more often accompanies
Often, pleurisy becomes the main and most serious clinical problem of an oncologic patient, it also often passes unnoticed and is noted long after banal pneumonia.
Causes of Pleurisy
Normal human physiology involves the mandatory presence of several milliliters of serous exudate in both pleural cavities, facilitating friction of the pleural sheets when the volume of the lung changes during
In chronic diseases and malignant tumors with metastases in the pleura, the balance of exudate intake and removal is disturbed. In lung cancer and heart disease, fluid production increases due to inflammation or slower blood flow, and the absorption remains stable, and a constant excess is formed.
In malignant tumors, several mechanisms of excessive production of pleural exudate are activated:
- Metastases on the pleural sheets squeeze small blood vessels, which increases the blood pressure in them and causes plasma to sweat through the wall;
- Cancer cells clog the lymph gaps and block the lumen of the vessels, interfering with the absorption of fluid;
- Cancer emboli thrombate small vessels, increasing intravascular pressure and causing stagnation;
- An inflammatory shaft is formed around the tumor tissue, which additionally disrupts the blood flow in the block of blood and lymph movement through the vessels;
- Mechanical obstruction to normal lung movements causes vascular congestion with edema of the lung tissue;
In severe cancer ascites, a «reflex» effusion of small volume may occur, regressing after ascites.
Pleurisy can occur with any malignant tumor, but most often develops with pleural metastases of breast cancer and germinating pleura lung cancer, characteristic of pleural mesothelioma.
When cancer pleurisy appears, its cause is not as important as the choice of the optimal therapeutic strategy aimed at delaying or completely stopping the production of exudate.
- For the reason that caused the formation of exudate, divided into inflammatory (infectious), aseptic, traumatic, malignant (tumor or metastatic).
- By localization of effusion: encased (delimited) and diffuse.
- By the nature of the fluid formed: serous, hemorrhagic, purulent, chyle, mixed.
- By volume of fluid: basal (supraphrenic), subtotal, total.
Only the gradation is always the same due to the formation of effusion, all other characteristics may change: the basal effusion grows to a total and vice versa with effective treatment; serous over time becomes hemorrhagic; diffuse gradually absorbed and accumulated.