Pleural effusion is the presence of liquid between the layers of the pleura, protective membrane around the lungs.
The pleura is normally composed of two layers (one on the inner side of the rib cage, the other on the lung) which slide on one another during the breathing movements in a virtual space between the two. A pleural effusion (pleurisy), the space is filled with liquid.
Puncture distinguishes exudative pleural effusion associated with inflammation with many proteins (infection, cancer), pleural effusion transsudatif linked to heart failure. Puncture therefore highlights the effusion of forming mechanism.
Origins of pleural effusion
The number and the evolution of pleural effusion depends on the cause.
If pleural effusion transsudatif related to heart failure (1-3% of the general population and more than 5% after 75 years), the treatment is effective and regressed effusion.
If exudative effusion linked for example to cancer, the prognosis is one of the causal disease. Meanwhile mesothelioma is a cancer of the pleura associated with exposure to asbestos, and is constantly growing.
Causes and mechanisms of pleural effusion
The pleural space normally contains very little fluid and proteins. The liquid from the bloodstream and it is locally absorbed by the lymphatics.
In heart failure, the heart struggles to pump blood stagnating upstream in the lungs (pulmonary edema) and tends to accumulate in the pleura as to form a transsudatif pleural effusion by increasing the pressure.
In case of inflammatory process (cancer, infection), vascular permeability is increased and favors the passage of liquid in the pleura: one speaks of exudative effusion.
Pleural puncture allows the analysis of pleural fluid and directs the cause. In case of clear liquid protein content information on the origin: a lot of protein = exudative, little protein = transsudatif.
When the pleural effusion is large, the liquid prevents the lungs to move, causing respiratory difficulty.
Symptoms and signs of pleural effusion
Symptoms depend on the abundance of pleural effusion and its cause.
Sometimes the discovery is fortuitous on a chest x-ray as pleural effusion is asymptomatic. Otherwise, the pain is the main point of call. It is of gradual onset type gravity or next point and raised on deep inspiration or coughing. Difficulty breathing signs occur when the effusion is important.
There are no clinical difference between exudative effusions and transsudatifs. However, the underlying disease causes symptoms that are specific as edema, shortness of breath (heart failure) or fever, weight loss (infection, cancer).
With what he does not confuse pleural effusion?
Any chest pain should receive a medical examination because it can be a heart attack, pulmonary embolism, ulcers or pneumonia or pneumothorax (air in the pleural cavity). Only the doctor can make a diagnosis, especially after the completion of exams.
Pneumothorax is also a filling of the pleural space, not by a liquid, but by air. The risk of asphyxia by compression of the lungs.
Will it possible to prevent pleural effusion?
There is no specific prevention.
Prevention of mesothelioma is through non-asbestos exposure. Smoking cessation is also recommended to reduce the risk of cancer.
In heart failure, relapse prevention through compliance with prescribed treatments and lifestyle changes (diet without salt or low-salt in particular).
In case of pain, lying on the side of the effusion usually relieves, in addition to prescribed pain medication.
Pleural effusion: when to consult?
Any severe pain and prolonged chest or difficulty breathing requires medical attention or call the SAMU Centre 15.
If the pleural effusion is known and previously diagnosed, a consultation is necessary if symptoms worsen, modification of pain and / or shortness of breath more intense.
What does the doctor deal with pleural effusion?
The examination by the doctor clarifies history (occupational exposure to asbestos, smoking, infections ...), the characteristics of pain (spontaneous, when breathing, night ...) and impact.
A history of heart failure or pulmonary edema moving towards a transsudatif effusion. Clinical examination confirmed the pleural effusion by percussion of the chest with fingers: the sound reflects a perceived dullness and auscultation shows a lack of breathing the area.
A chest x-ray and / or CT scan (or scan) are generally prescribed to highlight the effusion.
Pleural puncture under local anesthesia is the key consideration; introducing a needle in full area effusion, pleural fluid was removed and analyzed. His exudative or transsudatif character is then determined and guide treatment.
In case of repetition or by diagnosis, surgical bonding by talc pleurodesis is sometimes indicated to pick the pleura. Specific treatments depend on the cause: antibiotics for infections, heart condition treatment in case of transsudatif effusion in cases of mesothelioma chemotherapy or surgery ...
How to prepare for my next visit?
If pain or breathing difficulties majorem, it is necessary to re-consult. Chest radiography control allow you to see the evolution of pleurisy (liquid volume).
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