With sufficient accumulation of pleural fluid, an experienced oncologist will suspect the problem already when talking with the patient, having noticed cyanosis, the blue of the skin of the nasolabial triangle, against the background of the pallor of the face and the «breathlessness» of the patient’s speech. Listening with a stethoscope and tapping the chest wall will allow to determine the localization, including bilateral pleurisy and the approximate volume of fluid.
X-ray exudate is detected a little more than a glass, and CT or MRI can assess the condition of the pleural sheets and lung tissue, determine the size of metastases.
Treatment of the disease, especially with punctures, will require repeated and frequent monitoring of the condition of the pleural cavity radiographically or, which is harmless, ultrasonically (UST). With fluid getting encased, ultrasound of the chest cavity allows you to schedule a point for optimal puncture.
In case of primary effusion, when there is no clarity with the cause, the exudation obtained during puncture is necessarily subjected to microscopy for verification — confirming its malignant nature.
Most common, small pleurisy can go unnoticed, because the clinical manifestations are caused by changes in the volume of the pleural cavity and restriction of respiratory movements: the more fluid, the more pronounced signs of respiratory failure and symptoms of the disease.
Leading manifestations of the disease:
- Dyspnea, which begins with a barely noticeable lack of breathing during physical exertion and comes to severely relaxed when the patient is forced to take a position that allows him to breathe at least superficially;
- The heartbeat increases due to a change in the position of the heart, pushed aside by the fluid towards the healthy lung, interruptions are possible — extrasystoles and heart rhythm disturbances during movement;
- Dry cough and seizures — reflex due to metastases irritation of the nerve endings on the pleura;
- Feeling of heaviness in the chest and local pain during inhalation;
- Weakness and swelling of the legs — a sign of the ineffectiveness of cardiopulmonary activity;
ncrease in temperature to subfebrile as a result of stagnation of blood and activation of local microflora or absorption of degradation products of tumor tissue.
The combination of the symptoms can lead to a serious condition and immobility of the patient, when an urgent need to take resuscitation inherently measures — emergency evacuation of pleurisy.
Treatment of a pathological effusion into the chest cavity consists in evacuating excess fluid during pleural punctures and a systemic effect on the cause of it — cancer or metastasis.
Puncture — pleurocentesis is performed only in the presence of pronounced symptoms of respiratory failure or for cytological examination of the fluid. The procedure is not complicated, but penetrating into the body is invasive and therefore involves possible but very infrequent complications:
- damage to the lung by a needle with the development of pneumothorax, which aggravates the severity of the patient’s condition;
- rupture of the pulmonary bulla — excessively swollen pulmonary segment, which is formed during adhesions between the pleural sheets;
- injury of the neurovascular bundle in the intercostal space is painful, but passes without long-term consequences;
- infection of the cavity;
- the formation of adhesions, in a sense, this is useful, since the delimitation of the site is accompanied by a decrease in exudation.
Before the puncture, pleurocentesis and after it the control X-ray examination is obligatory in order to detect pneumothorax in time and conduct its emergency treatment.
The manipulation itself is carried out in a small operating room with sterility and under local anesthesia. First, the doctor in the intercostal space passes through the chest wall with a needle, through which a catheter is inserted inside, which is connected to the active aspiration system. After removal of the maximum possible amount of pleural effusion, a drug can be introduced into the cavity to reduce the rate of accumulation of exudation and sticking of pleural sheets — pleurodesis.
Chemotherapy, both intravenous and local, contributes to the elimination of pleurisy — cytostatics and other drugs are administered through the catheter into the chest cavity.
But antitumor treatment alone is not enough, because a patient with pleurisy suffers from concomitant pulmonary and heart failure, which significantly ruins his life, reduces his activity and appetite.
The treatment of such difficult patients is possible only by a team of specialists, together with oncologists, a thoracic surgeon and a cardiologist, a medical nutrition specialist and a rehabilitation specialist must work hand in hand. Such a team of professionals has already been established at the Medicine 24/7 clinic and our patients see the result of professional actions on themselves.