What is the accumulation of fluid in the pleural cavity called? Examination of the pleural fluid

Date of: 03.03.2020

Hydrothorax of the lungs is a dangerous pathological condition in which an excess amount of fluid accumulates in the pleural cavity of the lungs.

Hydrothorax is not independent disease, but is a complication of a number of diseases respiratory tract, and is also a sign of the development of cardiovascular pathologies.

The fluid in the pleural cavity does not allow the lung to fully expand when inhaled, it presses the lung from below.

If pathological fluid begins to accumulate in the pleural cavity, hypoxia develops - oxygen starvation of tissues and organs. Oxygen deficiency occurs in the tissues of the heart. The end products of metabolism, which have toxic properties, are poorly excreted from the body.

Symptoms appear suddenly, the manifestations of the pathology increase rapidly. The patient becomes extremely restless. Because at night I'm sick long time is in the supine position chronic diseases it is at this time of day that an acute illness often develops suddenly pulmonary insufficiency.

Causes of hydrothorax

Fluid in the pleural cavity is always a sign and complication of a disease. By itself, hydrothorax does not occur.

Causes of hydrothorax development:

Cardiovascular insufficiency. In chronic cardiovascular insufficiency against the background of pericarditis or heart disease, pleural fluid fills the lung cavity gradually. At acute development pathology, its urgent pumping is necessary due to the risk of suffocation.
Severe pathology of the kidneys. Hydrothorax in this case appears when kidney failure against the background of a violation of the functioning of the kidneys due to a serious illness. Most often it is glomerulonephritis with nephrotic syndrome. This fills both lungs with fluid.
Cirrhosis of the liver. With cirrhosis of the liver, the liquid fills the lungs not always, but only in 1 case out of 10. Hydrothorax in cirrhosis is right-sided. It develops when fluid abdominal cavity enters the pleural cavity through a hole in the diaphragm. Fluid can also enter the lungs during dialysis.
The appearance of a tumor in the mediastinum. The mediastinum is the place between the lungs. Appearance malignant neoplasms in this place is uncommon, but one of their symptoms may be the formation of fluid in the lungs. The tumor gradually leads to the fact that the normal blood flow is disturbed, and the outflow of lymph is blocked, which provokes the accumulation of fluid in the lungs.
Pneumonia. Most diseases of the respiratory system do not provoke an imbalance of pressure between blood plasma and hydrostatic pressure in the capillaries. Fluid in the lungs with pneumonia appears only with a complication of the disease or in the case of a long absence of treatment.
Anemia and lack of vitamins B and C.

Symptoms of the development of hydrothorax

Symptoms of hydrothorax directly depend on the amount of fluid that is in the pleural cavity.

If volume pleural fluid insignificant, its amount does not exceed 150 ml (such a hydrothorax is called small), then this condition has practically no effect on the course of the underlying disease. With total hydrothorax, when the liquid fills almost the entire lung cavity in humans, bright Clinical signs pathology.

Most often, water accumulates either only in the right lung, or in both at the same time. rare form considered left-sided hydrothorax. It appears with cardiovascular insufficiency, when fluid can accumulate not only in the pleural cavity or in the lungs, but also in the abdominal region.

Usually, pulmonary hydrothorax develops gradually, and its clinical signs increase as the pleural cavity of the lungs fills with fluid.

Signs of the development of hydrothorax:

Gradually increasing shortness of breath, which especially torments people during physical exertion.
In the lower parts of the pleural cavity of the lungs, which are primarily filled with fluid, heaviness and discomfort are felt.
With hydrothorax, there is no pain, as well as temperature. There is no inflammation in the protein contained in the liquid, so the person does not feel any signs of intoxication.

It is possible to determine hydrothorax not only by analyzing the patient's complaints, but also by visual examination. Due to constant shortness of breath and discomfort in the chest, a patient with hydrothorax constantly strives to take a certain position. Dyspnea is slightly relieved when the patient lies down on the side of the affected lung or squats a little.

If you suspect the development of hydrothorax, you should pay attention to the patient's stomach. Because of a large number fluid not only in the lungs, but also in the abdominal cavity, the abdomen may increase. At cardiovascular diseases fluid enters the fatty layer, which is manifested by soft tissue edema.

With cirrhosis of the liver, hydrothorax has its own specific symptoms. At similar reason the development of pathology in the patient begins severe shortness of breath, even with a small accumulation of fluid in the lungs. With cirrhosis of the liver, infection of the hymen may occur due to the ingress of bacterial flora into its area.

Diagnosis of hydrothorax

Diagnosis is one of the main stages in the treatment of hydrothorax. The faster and more accurately it is carried out, the more effective the treatment will be.

Diagnosis of hydrothorax includes the following items:

The initial collection of anamnesis, which necessarily includes an examination of not only the lung area, but also a survey of the patient on the fact of diseases of the liver, kidneys, of cardio-vascular system and respiratory organs.
Visual examination of the patient. During it, the doctor examines the tissues of the sternum and abdomen, listens to breathing and pulmonary sound, percussion of the borders of the heart.
Mandatory use of radiation and ultrasound diagnostic methods: fluoroscopy, ultrasound, computed tomography.
Analysis of urine.
Carrying out a puncture with a study of the fluid of the lungs and pleural cavity for the presence of fungal, viral or bacterial microflora in it.
Biochemical analysis of blood with the determination of the total amount of protein in the blood.
Rivalta test. If it is negative, the patient is diagnosed with hydrothorax.

X-ray is the most accessible and effective form diagnosing the presence of fluid in the lungs. The picture allows not only to determine the presence of fluid, but also to determine its approximate volume and localization. X-ray also allows you to determine the presence or absence of neoplasms in the area of concentration. Ultrasound helps to determine how much fluid in the pleural cavity of the lungs affects respiratory system and determine its exact amount in the pleural cavity. With the help of computed tomography, the main cause of the development of hydrothorax and the effect of the accumulated fluid on other organs and tissues of the sternum are determined.

Pleural puncture is performed only when the presence of fluid in the lungs has been accurately established using previous methods. The puncture is performed jointly by a surgeon and a pulmonologist. This does not require any preparation on the part of the patient, the operation is performed under local anesthesia. Analysis of the pleural fluid helps to determine the presence of an inflammatory element and pathogenic microflora in the lungs.

The puncture is carried out using a special tool - a trocar. The patient is in a half-sitting position, and the head is placed on folded arms. A puncture does not perform a full-fledged operation, but nevertheless there is a risk of infection, as well as damage to the integrity of the lung, diaphragm, liver, etc.

Urinalysis is performed to exclude or confirm kidney disease as the cause of hydrothorax. In this case, the presence of protein, leukocytes and erythrocytes in the urine is determined.

In liver diseases, as the cause of fluid in the lungs, a diagnostic operation may be performed to visualize damage and holes in the diaphragm and pleural cavity.

Treatment of hydrothorax of the lungs

Hydrothorax is never a primary disease, therefore, with the accumulation of fluid in the pleural cavity of the lungs, it is urgent to identify and develop a treatment plan for the underlying disease. If this does not happen, the patient has a progression of the main symptoms of pulmonary hydrothorax up to acute heart failure and respiratory arrest.

With a pathology of a cardiovascular nature, it is necessary first of all to adjust the patient's lifestyle. The treatment in this case is not to take a wide range medicines, but in a rational diet and, as far as possible, avoiding stress and nervous shocks. During treatment, it is necessary to adhere to a strict regime of work and rest, night sleep must last at least 8 hours. Nutrition correction lies in the fact that the diet should be crushed, and the use of any drinks and salt is strictly normalized.

With the formation of fluid in the lungs and in the pleural cavity due to disruption of the cardiovascular system, the patient needs to take drugs that relieve excess stress from the heart and remove excess fluid from the body. At the same time, the level of protein in the blood and the amount of fluid in the body should be strictly controlled. It is necessary to reduce the amount of drinks consumed, but in no case to allow dehydration.

Treatment for renal form hydrothorax involves mandatory bed rest, especially with a serious pathology of the renal system. Urinalysis for protein is regularly done, and salt is completely excluded from the diet. Diuretics for kidney damage are prescribed with very high caution, the main task of medications is not only to reduce the amount of fluid in the body, but also to reduce the amount of protein in the blood.

If the cause of the formation of a large amount of fluid in the pleural cavity of the lungs is liver disease, in most cases, removal of the affected tissues and transplantation of a new organ is suggested.

If it is possible to save the organ, the patient is prescribed a range of diuretic drugs. With hepatic hydrothorax, the patient needs additional therapy to avoid infection of the tissues and organs of the chest. For this, a wide range of drugs with antibacterial and antiviral effects are prescribed.

With total hydrothorax, the patient urgently undergoes an operation to pump out the fluid. Its technique is identical to the technique of pleural fluid puncture.

Removal of fluid from the body

The basis of the treatment of hydrothorax is the removal of excess fluid from the body in order to prevent its accumulation in the lungs. Therefore, traditional medicine can be used to treat this disease.

One of the available and safe diuretics is parsley.

It can be used as a diuretic decoction. To do this, parsley is poured with milk, and then evaporated to half. The resulting decoction must be taken in 1 tbsp. l. every hour.

If the cause of the accumulation of fluid in the lungs is not kidney disease, viburnum berries can be used. It can be a decoction, fruit drink, compote, or just berries covered with sugar. Kalina needs to be eaten on an empty stomach. She not only has an easy diuretic effect but also replenishes the body's need for vitamins and minerals.

Conclusion

Fluid in the pleural cavity is a dangerous situation for the patient. With this pathology, there is often a series of severe complications if there is no timely health care. To prevent lethal outcome urgent adequate measures are needed, since a person can live without air for only a few minutes.

It is difficult to measure the amount of fluid that occupies a shape other than spherical in the pleural cavities using the volume formula.

A method for estimating the approximate amount of fluid based on typical features of the echo pattern corresponding to each volume has been described above. The main difficulties stem from the impossibility exact definition the depth of the liquid, especially in the interlobar fissures. In clinical practice, many medical institutions it is quite enough to confine ourselves to a verbal description of the amount of effusion (“insignificant”, “moderate”, “massive”).

One way to approximate the volume of a pleural effusion is to estimate the amount of fluid using software scanner to the "area-length" or "ellipse" formulas. It can be used to determine the volume of encysted fluid or a relatively small free effusion in the posterolateral sections of the pleural cavity (before the formation of a single subpulmonary fluid layer).

With an occluded effusion, its size is measured and the area is calculated planimetrically by tracing along the contour or overlaying an ellipse of the appropriate size. Tracing the effusion is carried out along the edge of the anechoic space without capturing echogenic pleural overlays.

In the case of free effusion, the volume is calculated with a certain error, since its exact determination is impossible due to the complex geometric configuration of the fluid. To determine the volume using the "ellipse" method, a longitudinal section with a maximum area of anechoic content is selected. All echogenic structures located against an anechoic background are included in the determined volume, which leads to some overestimation of the calculated amount of fluid.

In the domestic and foreign literature various attempts have been made to develop an optimal formula that allows you to accurately calculate the amount of effusion. Here are a few of them:

1. There is a formula for calculating the amount of fluid (in ml) in the pleural cavities : Volume (in ml) = (H+A) × 70 , where A is the distance from the diaphragm to the basal edge of the lung, H is the distance from upper bound liquid level to the dome of the diaphragm (Fig. 32).

Rice. 32. Determination of the volume of pleural effusion by the distance of the lower edge of the lung from the diaphragm and the height of parietal distribution

2. Assessment of the volume of pleural effusion by the thickness of the effusion (in millimeters). The thickness of the lateral fluid layer between the basal surface of the lung and the chest wall is determined with the patient in the supine position. The possible spread of the determined amount of effusion is given in table. one

Table 1

Determining the volume of pleural effusion by thickness
effusion (mm)

The scheme for determining the volume of pleural effusion by the thickness of the parietal effusion is shown in fig. 33.

Rice. 33. Determination of the volume of pleural effusion by the thickness of the effusion, in mm

3. Calculation of the amount of fluid in the pleural cavity according to the Simpson equation.

The volume of fluid in the pleural cavity can also be calculated using the Simpson equation or the B-mode area-length formula (Fig. 34). To do this, the image is “frozen”, the volume of fluid in the pleural cavity and the volume of the edge of the lung are taken as the final diastolic volume. For the final systolic volume take the volume of the edge of the lung.

Stroke volume, that is, the difference between the two volumes, will be the approximate amount of fluid in the pleural cavity. This method should not be used with a large amount of fluid in the pleural cavity.

Rice. 34. Calculation of the amount of fluid in the pleural cavity
by Simpson's equation

For convenience practical application it is possible to conditionally divide all pleurisy, depending on the amount of pleural fluid, into: 1) minimal (X-ray negative) - up to 50 ml; 2) small (from 50 to 150 ml); 3) medium (from 150 to 500 ml); 4) large (from 500 ml to 1 l); 5) massive (more than 1 l). This separation of effusions allows you to more clearly define the indications for pleural puncture.

If necessary, the level of near-wall distribution of fluid can be determined from the intercostal spaces by sequentially scanning chest from bottom to top in the transverse plane, and simply indicate up to which edge the liquid is registered.

The given volumes of effusions corresponding to different options their echo pictures are quite approximate. However, there is no need to calculate the volume of contents with an accuracy of a milliliter, which, however, is impossible, given the complex spatial configuration of the pleural cavity and the presence of echogenic structures in it. More important is the determination of the optimal site for puncture and the nature of the fluid contained.

The fluid in the pleural cavity is a serious pathological condition that indicates a disease or a violation of vital activity, the work of the body. In certain situations, the fluid in the pleural region provokes decompensation of the respiratory degree of insufficiency, which is very serious for a person, because it can cause death. In this regard, treatment must be carried out as quickly as possible.

The concentration of fluid in the pleural region is always associated with diseases of a secondary nature. This means that the presented condition is formed as a syndrome on the basis of another disease, which is this moment flows in the body.

The main causes, and therefore potential treatment, lie in the following diseases and processes:

trauma to the sternum, leading to rupture of blood vessels located between the ribs or in the lung parenchyma;
diseases of the inflammatory nature of the peritoneal organs, in which there is a forced excretion of exudate, as a reaction to pancreatitis or multiple abscess;
oncological pathologists that affect the pleura within the primary focus, as well as when dividing into metastases, is one of the most unfavorable prognosis;
insufficiency of cardiac function, in which there is a distortion of hydrostatic pressure in the blood.

Another factor that needs to be treated is pneumonia. The focus in this case may be located deep in the lung parenchyma and in proximity to the pleural region. As a reaction of the body to the inflammatory process in the lungs, an effusion of a specific fluid is noted - a small amount is released.

More about the reasons

Additional developmental factors that are more rare include infectious and allergic pathologies. It's about rheumatism and arthritis. rheumatoid type. Tuberculosis is the next condition. acute course which may occur manifestation associated with pleurisy.

Puffiness of the mucosa, or myxedema, is formed as part of the insufficiency of the endocrine gland, while the smallest amount of mucus is secreted. Another rare pathological condition is pulmonary embolism, in which there is pulmonary infarction with further removal of the transudate.

In some cases, there is uremia (a consequence of renal failure) and connective tissue diseases systemic. We are talking about systemic lupus erythematosus, periarteritis nodosa, the treatment of which is the most problematic, because the causes are difficult to identify.

Condition symptoms

The accumulation of fluid in the pleural cavity has certain symptoms, which include pain on the right or left side, as well as a dry cough. The latter is formed as part of the compression of the bronchial region, which is affected by the accumulated volumes of fluid. TO additional symptoms relate:

The last two symptoms are associated with a chronic form of oxygen deficiency, which is lacking in tissues of the peripheral type.

Diagnostic measures

Most informative method is an x-ray that identifies the presence or absence of fluid. After that, they carry out additional tests: puncture, CT. The puncture allows you to determine which components are in the composition of the liquid. It is also restorative in nature, because it allows you to pump out a certain part of the liquid.

CT is the most informative, but also the most expensive method. Its advantage lies in the ability to determine the amount of fluid released and the factors that influenced the presented process. Pulmonologists insist on diagnostics every 5-6 months. This will identify the syndrome of accumulation of fluid in the pleural cavity and other pathological conditions, the treatment of which is necessary.

Recovery process

Therapy to exclude the formation of fluid in the pleura directly depends on the cause of its appearance. In this regard, it is necessary to treat the primary disease, upon successful completion of which a further recovery cycle is developed. If compensation and self-excretion of the fluid is successful, it will be possible to confine ourselves to antibiotic components.

Surgery is the main medical event, which allows you to remove any ratio of fluid from the body.

With the presented goal, the following treatment is carried out:

the puncture, which was mentioned earlier - it allows you to remove a small ratio of fluid;
direct or directional drainage, which removes any number of accumulations, but provokes significant injury to the skin;
surgical operation for local removal of fluid.

With the timely implementation of each of the presented types of intervention, it will be possible to achieve a quick recovery. However, in some cases, treatment is started too late and complications develop. Negative consequences, which will be discussed below.

Consequences and complications

The accumulation of a large amount of fluid in the pleural cavity can provoke many complications. They come down to following processes: infection and inflammation of the lung acute genesis, acute pulmonary insufficiency, problems with the function of the heart, liver and other internal organs.

Given the high probability of the spread of pus and fluid inside the abdominal region, complications can also be expected from the gastrointestinal tract. The presented type of fluid that has accumulated in the pleura is a factor that quickly affects the likelihood of death or disability. This may relate to the development of chronic renal failure, the need for resection of the spleen or part of the pancreas.

The risk of complications within the presented pathology is high in representatives of any age and gender, and therefore it is recommended to start treatment as early as possible and resort to preventive measures.

Preventive measures

Prevention of the condition is timely treatment primary diseases. Otherwise, even if the fluid in the pleura is excluded, it will accumulate again and in even greater quantities.

If surgery or antibiotic therapy is successful, you can proceed to additional measures impact. It's about managing healthy lifestyle life, exclusion bad habits, the use of vitamin complexes and preparations saturated with mineral and other useful components.

An obligatory stage of prevention that improves recovery is the introduction diet food and adherence to physical activity.

It is recommended to use the maximum ratio of seasonal vegetables and fruits, eat meat, natural proteins, fats and carbohydrates. Pulmonologists insist on daily exercise, walking and hardening. With this approach, therapy will be 100% effective.

The accumulation of fluid in the pleural cavity is a critical problem that requires the immediate intervention of a pulmonologist and surgeon. A full diagnostic examination and subsequent recovery, as well as the implementation of preventive measures that will help maintain maximum vitality.

The pleural cavity is a narrow space between the two layers of pleura surrounding the lungs: parietal and visceral. This anatomical feature is necessary for the implementation of the breathing process. Normally, the fluid in the pleural cavity is in small quantities and plays the role of a lubricant to facilitate the sliding of the pleura during breathing. However, with pathological changes, fluid contents can accumulate and interfere with the normal functioning of the respiratory function.

The pleural cavity is represented by a narrow gap in two asymmetrical sacs surrounding each lung. These bags are isolated from each other and do not communicate with each other. They consist of smooth serous tissue and are a combination of two sheets: internal (visceral) and external (parietal).

The parietal pleura lines the chest cavity and the outer mediastinum. The visceral pleura completely covers each lung. At the roots of the lungs, the inner leaf passes into the outer. The pulmonary skeleton and lining of the lobes of the lungs are formed from connective tissue visceral pleura. The lateral (costal) pleura at the bottom smoothly passes into the diaphragm. The transition points are called pleural sinuses. In most cases, the accumulation of fluid in the pleural cavity occurs precisely in the low-lying sinuses.

The negative pressure created in the pleural cavity allows the lungs to function, ensuring their position in the chest and normal work while inhaling and exhaling. If a chest injury occurs and the pleural gap is touched, then the pressure inside and outside is equalized, disrupting the functioning of the lungs.

The pleural fluid is represented by serous contents produced by the pleura, and normally its volume in the cavity is no more than a couple of milliliters.

The liquid content of the pleural cavity is renewed by its production by the capillaries of the intercostal arteries and is removed through lymphatic system through reabsorption. Since the pleural sacs of each lung are isolated from each other, if excess fluid accumulates in one of the cavities, it does not enter the adjacent one.

Most pathological conditions are inflammatory and non-inflammatory in nature and are represented by the accumulation of fluid of various kinds. Among the contents that can accumulate in this cavity, there are:

Blood. It is formed as a result of trauma to the chest, in particular, the vessels of the pleura membranes. In the presence of blood in the pleural cavity, it is customary to speak of hemothorax. This condition is often the result surgical operations in the chest area.
Chylus in cases of chylothorax. Chylus is a milky-white lymph with a high lipid content. Chylothorax occurs when closed injury chest as a complication after surgery, as a result of tuberculosis and oncological processes in the lungs. Often chylothorax is the cause of pleural effusion in newborns.
Transudate. Edematous fluid of a non-inflammatory nature, formed as a result of a violation of blood circulation or lymph circulation (in case of injury, for example, burns or blood loss, nephrotic syndrome). Hydrothorax is characterized by the presence of transudate and is a consequence of heart failure, mediastinal tumors, cirrhosis of the liver, etc.
Exudate. An inflammatory fluid produced by small blood vessels in inflammatory lung diseases.
Accumulated pus, formed during inflammation of the pleura itself (purulent pleurisy, pleural empyema). Formed due to inflammatory processes in the lungs, acute and chronic form, tumor and infectious processes, as well as as a result of trauma to the sternum. Requires urgent treatment.

When pathological changes in the chest are detected or in the presence of characteristic symptoms(breathing problems, pain, cough, night sweats, blue fingers, etc.) is necessary urgent hospitalization. To determine the nature of the accumulated fluid, a puncture is performed and x-ray examination to identify its location and prescribe treatment.

The causes of pleural fluid of various etiologies can be the following:

chest injury;
inflammatory diseases (pleurisy, etc.);
oncology (in this case, during microscopic studies of the taken material, cricoid cells are found, confirming the diagnosis);
heart failure.

Pleural effusion is an accumulation of fluid contents of pathological etiology in the pleural cavity. This condition requires immediate intervention, as it is a direct threat to human life and health.

Pleural effusion is most often diagnosed in patients with impaired lung function, in more than half of cases inflammatory diseases lung cavity - in 50% of patients with heart failure and in about a third of patients with HIV in history.

The cause of the effusion can be both transudate and exudate. The latter is formed as a result of inflammatory diseases, oncological processes, viral and infectious lesions lungs. In case of detection of purulent contents, it is customary to speak of purulent pleurisy or pleural empyema. This pathology is observed in all age groups and even when intrauterine development. In the fetus, pleural effusion can be triggered by hydrops of the immune or non-immune type, chromosomal abnormalities, and intrauterine infections. Diagnosed in the II and III trimesters by ultrasound.

Symptoms of the presence of such pathological condition as pleural effusion:

dyspnea;
soreness in the chest;
cough;
weakening of the trembling of the voice;
weakness of breath sounds, etc.

If such signs are identified during the initial examination, additional studies are prescribed, in particular, x-ray and cellular analysis of the pleural fluid, determining its nature and composition. If, according to the results of the analyzes, it was possible to determine that the fluid in the cavity is nothing but exudate, then additional studies are carried out and inflammatory processes are stopped.

Treatment Methods

If the pleural effusion is latent and asymptomatic, then in most cases no treatment is required and the problem resolves on its own. In symptomatic conditions of this kind, the pleural cavity undergoes a process of evacuation of liquid contents. It is important to remove no more than 1500 ml (1.5 l) of liquid at a time. If the exudate is removed at a time in full, there is a high probability of forced development of pulmonary edema or collapse.

Chronic pleural effusions frequent relapses are treated by periodic evacuation, or by installing drainage in the cavity, so that the exudate or other contents are removed into a special container. Inflammation of the lungs and tumors of a malignant nature that provoke effusions require specialized individual treatment.

Drug treatment of diseases associated with the accumulation of fluid in the pleura is carried out with early detection pathologies and is very effective in the early stages of the development of the disease. Both antibiotics and combination therapy with broad-spectrum drugs are used.

In advanced cases or if the therapy is ineffective, a decision may be made to surgical intervention. In this case, the pleural cavity and sternum are cleared of fluid. operational method. Currently, this method is considered the most effective, but it has a number of complications, up to death.

Surgical intervention is an extreme measure to rid the patient of the pleural effusion syndrome and has a number of limitations: age up to 12 years, as well as age after 55 years, pregnancy and lactation, general exhaustion of the body. In the above cases, the operation is performed with a direct threat to life and when alternative treatment is impossible.

The space between the lung and the chest contains the pleural cavity. pleural fluid for lubrication of the pleura sheets - parietal (parietal) and visceral (pulmonary). The parietal pleura covers the chest, mediastinum, diaphragm and ribs, the visceral pleura covers the lungs and enters deep gaps between its lobes. The right and left pleural cavities are separated from each other by the mediastinum.

Pleura It is built from a single layer of cells - mesothelium, which produce pleural fluid and constantly filter lymph.

Norm

The volume of pleural fluid is normally 0.13 ml/kg of body weight, which is 10 ml for a person weighing 70 kg. It is clear (with a slight yellowish tint), sterile (no bacteria or viruses), and contains very few cells. The level of glucose is the same as in the blood, a minimum of protein and almost zero concentrations of enzymes, fats, lactic acid.

Pleural effusion

Pleural effusion- this is a pathological accumulation of fluid in the pleural cavity, a symptom of diseases of the lungs, pleura, heart and other organs. Pleural effusion occurs when there is an imbalance between the formation of pleural fluid and its reverse suction into the blood.

The appearance of pleural effusion is a symptom of the disease and requires urgent diagnosis and treatment.(not always).

1.5 million cases of pleural effusion are diagnosed annually in the United States, or 320 cases per 100,000 population per year in developed countries, mostly in older people.

The main causes of pleural effusion

congestive heart failure
tuberculosis and pneumonia
tumors
embolism pulmonary artery

Pathogenesis

The mechanism of occurrence of pleural effusion in each individual disease is different.

increased permeability of the pleura - inflammation, neoplasms, embolism
decrease in oncotic pressure of proteins in the blood - nephrotic syndrome and cirrhosis of the liver
increased capillary permeability or massive vascular rupture - trauma, tumors, inflammation, infections, pulmonary infarction, allergy to medications, uremia, pancreatitis
increased hydrostatic pressure - heart failure, superior vena cava syndrome
reduced pressure in the pleural cavity and the inability of the lung to fully expand on inspiration - atelectasis and lung fibrosis
insufficient drainage of lymph or complete blockade lymph nodes trauma, tumors
increase in the volume of peritoneal fluid in the abdominal cavity and its penetration through the diaphragm - cirrhosis of the liver, peritoneal dialysis
movement of fluid into the pleural cavity with pulmonary edema

With pleural effusion, the dome of the diaphragm becomes flat, the distance between the sheets of the pleura increases, the lung is compressed and the heart, esophagus, trachea, and vessels are displaced, which is manifested by respiratory failure and shortness of breath.

And here there is a need for a pleural puncture - removal of part of the pleural effusion.

Indications for pleural puncture

Indication for pleural puncture- unexplained accumulation of fluid in the pleural cavity, which is accompanied by shortness of breath, chest pain, cough, sometimes with fever and.

During a pleural puncture, several tubes are filled with pleural fluid and sent to the laboratory for analysis.

What are they researching?

physical properties - quantity, color, smell, acidity
biochemical parameters -, and others
smear microscopy
testing for infections

Pleural fluid analysis carried out to diagnose the causes of accumulation of fluid in the pleural cavity. The procedure for taking fluid for research - pleural puncture or thoracentesis.

Pleural fluid is normal

Appearance - clear transparent
pH 7.60-7.64
total protein up to 2% (1-2 g/dl)
up to 1000 in mm 3
glucose - equal to the level in the blood
LDH - below 50% blood levels

There are two main types of pathological pleural fluid - transudate and exudate.

transudate

Transudate in the pleural cavity- the result of an imbalance between the pressure inside the vessel and outside it.

Causes

congestive heart failure - the left ventricle is not pumping enough blood out of the lungs
cirrhosis of the liver with a decrease in total protein and albumin, which normally retain fluid inside the vessel
atelectasis - collapse of the lung when air is blocked by the bronchus in case of tumors or blockage of the pulmonary artery
nephrotic syndrome - blood proteins are lost in the urine
peritoneal dialysis - a method of purifying the blood when the kidneys are not working
myxedema - severe deficiency
adhesive pericarditis - adhesion of the sheets of the lining of the heart (pericardium)
leakage of cerebrospinal fluid into the pleura - with ventriculopleural shunting, trauma, or after operations on the spinal cord
duropleural fistula is a rare complication of spinal cord surgery
displacement of the central venous catheter

Transudate properties

The transudate is transparent, the levels of total protein, albumin and LDH are reduced, the concentration of glucose is the same as in the blood, total amount cells - normal or slightly increased.

Pleural fluid with transudate properties involves only 6 tests - assessment of external properties, total protein, albumin, glucose, LDH and microscopy.

Exudate

damage and inflammation pleura leads to the appearance of exudate.

Causes

pneumonia - inflammation of the lung
malignant neoplasms - lung cancer, pleural cancer (mesothelioma), metastases of other tumors (breast cancer, lymphoma, leukemia, less often - ovarian cancer, stomach cancer), sarcomas, melanoma
pulmonary embolism - blockage of the pulmonary artery by a blood clot
connective tissue diseases rheumatoid arthritis, systemic lupus erythematosus
pancreatitis - inflammation of the pancreas
chest trauma
esophageal perforation - direct communication between the esophagus and the pleural cavity, for example, with injuries of the esophagus, tumors, burns
fungal infection
rupture of a lung abscess into the pleural cavity
after heart bypass surgery
pericardial disease
Meigs syndrome is a combination of ascites and pleural effusion in benign tumor ovaries
ovarian hyperstimulation syndrome during in vitro fertilization
asbestosis - lung damage due to repeated contact with asbestos
severe chronic renal failure
fistula - connection of the pleural cavity with the ventricles of the brain, with the biliary tract, with the stomach
sarcoidosis
autoimmune diseases - rheumatoid arthritis and systemic lupus erythematosus
tumors - lymphomas, leukemias, lung cancer, lung metastases, pleural cancer
after heart surgery, lung and heart transplantation
abscess in the abdomen (liver abscess)

Exudate properties

The exudate is yellow and even yellow-greenish, turbid. total protein, albumin, LDH are significantly increased, total number cells - also exceeds the norm, and glucose - is reduced.

Additional exudate tests

, And ( , )
Gram stain - to detect bacteria and fungi
tank. culture for Mycobacterium tuberculosis
bakposev and antibiogram - will determine the type of bacteria in the pleural fluid and their sensitivity to various antibiotics to select the most targeted drug
fungal culture – fungal culture media and antifungal susceptibility testing
adenosine deaminase - for the diagnosis of tuberculosis
less often - tests for viruses

Analysis of pleural fluid in diseases

red pleural fluid tumor, pulmonary infarction, trauma, asbestosis, pleural endometriosis
white or milky color suggests chylothorax, usually due to trauma (eg, car accident, after surgery) or impaired lymph drainage (lymphoma, metastases)
black pleural fluid - infection with the fungus aspergilus ( Aspergillus niger)
green - fistula between the pleural cavity and the biliary tract or gallbladder
dark red-brown color - amoebiasis or rupture of an amoebic liver cyst
very viscous effusion characteristic of pleural mesothelioma or empyema
putrefactive smell pleural fluid occurs with empyema caused by anaerobic microbes, a breakthrough of a lung abscess into the pleural cavity
low pH(less than 7.3) pleural fluid - always means exudate, especially empyema, tumor, rheumatoid pleurisy, systemic lupus erythematosus, tuberculosis, esophageal injury
pH below 7.1-7.2 indicates the need for immediate drainage of pleurisy, and pH above 7.3 indicates pleurisy can be treated with antibiotics
pH less than 6.0 - damage to the esophagus
very high level LDH in pleural fluid(more than 1000 IU / l) occurs with empyema, rheumatoid pleurisy, paragonimiasis, malignant tumor, pneumocystic pneumonia (with AIDS)
glucose 1.6 - 2.7 mmol / l- tumor, tuberculous pleurisy, rupture of the esophagus, pleurisy with systemic lupus erythematosus
glucose in the pleural fluid below 1.6 mmol / l - rheumatoid pleurisy or empyema
lactic acid formed when bacteria consume glucose in the pleural effusion and increased in infections
amylase- pancreatitis, pancreatic pseudocyst, damage to the esophagus, peptic ulcer, necrosis small intestine(eg, thrombosis of mesenteric vessels)