What is pleural effusion (water in the lung)?
Pleural effusion, or water in the lung, is the accumulation of fluids within the pleura, the membrane that lines the lung. This build-up compresses the organ and causes difficulty in breathing, chest pain and shortness of breath. It is not a disease in itself, but a common manifestation of other diseases.
The pleura is a double membrane that lines the lung and assists in its movements. It consists of two layers: the visceral pleura, an inner layer that is glued to the lung, and the parietal pleura, an outer layer that is in contact with the other anatomical structures that surround the lung.
Inside the pleura, there is a structure known as the pleural cavity. This cavity is nothing more than a 0.02 mm gap between the two pleurae. In it, there is a small amount of serous lubricating liquid, which helps in movement, preventing friction when the lung fills or empties.
This serous liquid is released into the pleural cavity through blood capillaries in the outermost layer of the pleura (parietal). Then, this liquid is reabsorbed by the lymphatic system, so that it does not accumulate. Normally, about 15 milliliters of this liquid is found in the pleura of a normal person.
The condition of pleural effusion occurs when, for some reason, there is an overproduction of the serous fluid, or when the lymphatic system is unable to do resorption. Thus, the liquid accumulates in that cavity and begins to compress the lung, decreasing its capacity to store air.
Because it is not a disease itself, it is necessary to investigate the true cause of the stroke when it happens.
Pleural effusion can be classified in several ways, one of which is according to the chemical composition of the accumulated liquid. This liquid can be from the pleural fluid itself, with small changes, to blood and other secretions.
This classification is given in:
Characterized by a liquid that is poor in cells and proteins , light and transparent in color, similar to normal pleural fluid, this type of stroke happens because of the increase in pressure in the blood vessels or by blood that is low in proteins. Its most common cause is heart failure, followed by cirrhosis , ascites and hypoalbuminemia.
The liquid from this type of stroke is more viscous and opaque, rich in proteins and inflammatory cells. Sometimes it can be accompanied by blood and pus. This liquid occurs to the detriment of local processes that cause greater permeability, which results in the abundance of proteins, cells and other constituents of the serous liquid.
There are several causes for this type of stroke, the most common of which are pneumonia (parapneumonic pleural effusion), cancer with metastasis to the pleura, pulmonary embolism , autoimmune diseases such as lupus and rheumatoid arthritis, viral infections and tuberculosis .
The types of stroke can also be classified according to their character, that is, what is actually in the cavity. Understand:
Lymph accumulation in the pleural cavity, which has a milky appearance due to its high fat content. It is usually caused by trauma in the thoracic region, neoplasms, congenital causes, infections and venous thrombosis of the superior vena cava system (in the heart).
The liquid is similar to that of a chylothorax spill, but it is low in triglycerides and high in cholesterol.
Bloody fluid due to trauma, the result of a coagulopathy or even the rupture of an important blood vessel, such as the aorta or pulmonary artery.
I put it in the pleural cavity. It can be a complication resulting from pneumonia, thoracotomy, abscesses and infections.
Another way to classify a pleural effusion is according to its location in the pleura. Are they:
Infra-pulmonary or subpulmonary effusion
It occurs in the part of the pleura below the lung. It is not known why the liquid does not extend to the lateral parts of the pleural space;
When the effusion remains encapsulated in any part of the pleura, it is more common in hemothorax and empyemas;
Loculation between fissures (phantom tumor)
The lung is divided into lobes that are separated by fissures. Inside, there may be an accumulation of liquid, making it difficult to detect in the traditional chest X-ray examination, hence the name “phantom tumor”.
Lastly, there is the possibility of a trapped lung, a phenomenon in which a fibrous layer forms and surrounds the organ, preventing its expansion. It is usually caused by an empyema or tumor. The lack of movement of the lung increases the release of the transudative fluid, filling the pleural cavity more quickly, which causes the accumulation of fluid.
There are some risk factors that assist in the development of a pleural effusion. Are they:
- Smoking and alcoholic beverages;
- High pressure;
- Cardiac insufficiency;
- Autoimmune diseases;
- History of contact with asbestos (asbestos), highly carcinogenic substances.
As shown earlier, pleural effusion can be caused by malignant tumors. In most cases, this happens because the cancer cells metastasize and damage the pleura. In addition, stroke may occasionally appear as a side effect of cancer therapies, such as radio and chemotherapy.
The types of cancer most commonly related to pleural effusion are:
- Lung cancer;
- Breast cancer;
- Ovary cancer;
- Cervical cancer;
- Uterine cancer.
In general, symptoms are only felt when the stroke is of a moderate or large size, and even then, some people do not experience anything at all. The patient is more likely to experience symptoms only when there is inflammation in the pleura, as they are often masked by the symptoms of the abnormality causing the stroke.
Some symptoms that can be felt are:
- Shortness of breath (dyspnoea), even at rest;
- Chest pain, especially when taking a deep breath;
- Persistent hiccup;
- Dry cough;
- Elevation between the ribs (in more severe cases).
Depending on the cause, some patients may experience a fever . Chest pain is often described as “stinging”, and the symptom may improve when the patient lies down on the affected side. There is also the possibility of orthopnea, that is, the inability to breathe easily in other positions besides sitting or standing, with the spine erect.
If a pleural effusion is suspected, the patient should contact a general practitioner, who can perform physical examinations and listen to breathing through a stethoscope, trying to pick up changes. If the doctor becomes suspicious of a stroke, he may order some tests.
When there is a pleural effusion, the radiograph shows an abnormality: part of the lung area appears as a white spot. However, it is difficult to detect very small strokes and, therefore, there may be a need for further tests.
Computed tomography (CT)
Computed tomography provides more detailed images than normal radiography and can detect minor strokes.
Ultrasound of the chest
The ultrasound examination uses a probe that captures the sound waves (echoes) and converts them into images, being able to show the inside of the body efficiently. Therefore, it can be considered an alternative to radiographic examinations when radiation cannot be used. , as in the case of pregnant women, for example.
When none of the non-invasive tests give satisfactory results or there is a need to understand the nature of the stroke, thoracentesis can be performed. This exam consists of a puncture in the ribs, reaching the pleura, to collect the liquid contained in it and send it for analysis (biopsy).
Videopleuroscopy consists of the introduction of a mini-camera to analyze the pleura, while the patient is sedated by general anesthesia. It is a last resort to investigate the presence of a stroke, if none of the previous tests have shown conclusive results.
It is important to remember that rarely does a pleural effusion come unaccompanied, that is, it happens on its own, without another disease causing it. In cases in which the stroke is detected without knowing the specific cause, there is a need to carry out further tests to discover and treat the causing abnormality.
Fortunately, pleural effusion can be cured, but it can reoccur if the condition that causes it is not treated. Therefore, the main treatment must be related to the causative disease.
To treat the stroke itself, there are a few alternatives. Check out:
When the stroke is very large and causes many symptoms, drainage of the fluid through a thoracotomy is necessary. In this process, a tube is inserted into the pleural cavity and drains the excess fluid present. The procedure is performed with local anesthesia, so that the patient is comfortable, and can be performed at the same time as the thoracentesis is done.
Drainage may be necessary more than once, if the fluid fills the pleural cavity again.
In cases in which there is a great possibility of recurrence of the stroke, such as in patients with malignant neoplasms, pleurodesis can be performed. It is an invasive procedure (surgery) that, through catheters or tubes, injects a sclerosing substance that “glues” the walls of the pleura, eliminating the space where the liquid accumulates. The most commonly used substances are talc, silver nitrate and proliferating cytokines.
This surgery can be performed using several methods, such as through thoracotomy, through catheters, tubes, and even by video, using a mini-camera – a procedure that is called VATS, Video-assisted Thoracoscopic Surgery .
In extreme cases, such as malignancy, pleurectomy can be performed, surgery in which the affected part of the pleura is removed. It is also recommended in cases where there is infection, such as exudative strokes. In the postoperative period, the patient will still have the fluids drained for a few days or weeks.
An extremely important complementary treatment is respiratory physiotherapy. In general, it is recommended that the patient undergo respiratory physiotherapy sessions during the entire treatment, where he will learn exercises that will help to increase the respiratory amplitude, treating problems such as shortness of breath and pain from breathing.
Most cases of pleural effusion are easily resolved. Often, even without the need for invasive treatments, however, those who receive them may have to bear some pain and discomfort, due to punctures or surgeries.
There are some cases where there are dangerous complications, depending on the treatments done. Understand:
It may be a result of very rapid drainage during thoracentesis;
There is a small possibility that the pleura will be filled with air instead of liquid and thus cause a phenomenon called collapsed lung, which causes shortness of breath and, consequently, oxygen in the blood. This condition can also happen in both lungs and lead to death;
Infection or bleeding
Surgery can rarely lead to exaggerated infections and bleeding in the pleura or lung;
Also known as generalized infection, it can be caused or cause a stroke, and makes it difficult to drain fluid in advanced cases.
If the patient has undergone treatment and some symptoms persist or a complication is suspected, he should contact the doctor responsible for the procedures immediately.
There is no exact way to prevent water in the lung and the only known way to try it is by preventing stroke-causing illnesses when possible.
Having healthy attitudes, such as eating properly and exercising, helps prevent cardiovascular disease and certain types of cancer. Not smoking and reducing the consumption of alcoholic beverages also helps in the fight against chronic diseases.
Other measures to be taken are the adoption of hygienic habits that help to combat the proliferation of viruses, fungi and bacteria, thus avoiding contamination of people. In this way, spills caused by infections are avoided.
Pleural effusion is a common condition, which can happen to anyone, and usually indicates the presence of a more serious illness. So it is important that people know how to recognize symptoms and see a doctor as soon as possible.
This article seeks to inform what water in the lung is, how to recognize it and how the treatment is done. If you think it is important for people to understand what they are dealing with, share this text and let more people know. If in doubt, ask that we answer!