Hydropulmonary effusion, also known as pleural effusion, is a condition in which fluid accumulates in the pleural cavity due to rapid or slow absorption of fluid caused by various factors, including congestive heart failure, constrictive pericarditis, pleurisy, hypoproteinemia, and medications. Patients primarily experience chest pain, cough, and dyspnea. Depending on the cause, these symptoms may also include fever, shortness of breath, and cardiac insufficiency. While the prognosis for most patients is good, malignant pleural effusions are associated with a poorer prognosis.
Epidemiology
Contagious
Pulmonary effusion caused by some special pathogenic microorganisms may be contagious to a certain extent.
Incidence
Pulmonary edema is common in clinical practice.
High-risk population
There is no specific group of people for this disease.
Causes
Overview
Pulmonary effusion (pleural effusion) is common clinically and may be caused by lung, pleural, or extrapulmonary diseases. In addition, medications, radiotherapy, gastrointestinal endoscopy, and some surgeries can also cause this condition.
Basic cause
1. Increased hydrostatic pressure in pleural capillaries
Such as congestive heart failure, constrictive pericarditis, increased blood volume, obstruction of the superior vena cava or azygos vein, resulting in pleural effusion.
2. Increased pleural permeability
Such as pleural inflammation (tuberculosis, pneumonia), connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis), pleural tumors (malignant tumor metastasis, mesothelioma), pulmonary infarction, subphrenic inflammation, subphrenic abscess, liver abscess, acute pancreatitis, etc., which produce pleural effusion.
3. Decreased colloid osmotic pressure in pleural capillaries
Such as hypoproteinemia, cirrhosis, nephrotic syndrome, acute glomerulonephritis, myxedema, etc., which produce pleural effusion.
4. Parietal pleural lymphatic drainage disorder
Cancerous lymphatic obstruction, developmental lymphatic drainage abnormalities, etc. can cause pleural effusion.
5. Injury
Rupture of aortic aneurysm, thoracic duct, etc. can cause hemothorax, empyema and chylothorax.
6. Iatrogenic
Drugs (such as methotrexate, amiodarone, phenytoin, α-receptor antagonists), radiotherapy, gastrointestinal endoscopy and treatment, bronchial artery embolization, ovarian hyperstimulation syndrome, excessive fluid load, coronary artery bypass grafting or coronary stent implantation, bone marrow transplantation, central venous catheter rupture and peritoneal dialysis can all cause exudative or transudative effusions.
symptom
Overview
The main symptoms of pulmonary edema are chest pain, cough, and dyspnea. Depending on the cause, these symptoms may also include fever, shortness of breath, and cardiac insufficiency. As the disease progresses, complications such as bacterial infection, pleural adhesions, anemia, and severe heart and kidney failure may occur.
Typical symptoms
1. Dyspnea is the most common symptom in patients with pulmonary edema, often accompanied by chest pain and cough.
2. Tuberculous pleurisy is more common in young people, often with fever, dry cough, and chest pain. The chest pain may be relieved as the amount of pleural effusion increases, but chest tightness and shortness of breath may occur.
3. Malignant pleural effusion is more common in middle-aged and older patients. They usually have no fever, dull chest pain, and are accompanied by weight loss and symptoms of respiratory or primary tumors.
4. Inflammatory effusion is exudative and often accompanied by cough, sputum, chest pain and fever.
5. Pleural effusion caused by heart failure is a transudate and has other manifestations of heart failure.
6. The right pleural effusion associated with liver abscess may be reactive pleurisy or empyema, often accompanied by fever and pain in the liver area.
7. Palpitations and breathing difficulties are more obvious when there is a large amount of fluid accumulation.
complication
Pulmonary effusion is often complicated by bacterial infection, pleural adhesions, anemia, severe heart failure and renal failure.
examine
Scheduled inspection
Patients experiencing chest pain, cough, or difficulty breathing should seek medical attention promptly. Doctors will first perform a physical examination to identify any abnormalities. Doctors may then recommend routine blood tests, tuberculosis testing, tumor markers, X-rays, CT scans, ultrasounds, pleural effusions, bronchoscopy, pathology, thoracoscopy, or open-chest biopsy to confirm the diagnosis.
Physical examination
Doctors usually need to observe the patient’s overall condition and percuss the chest to preliminarily determine the extent of the effusion.
Laboratory tests
1. Blood routine test
Doctors can determine whether there is infection, anemia, etc. by observing the changes in the number and morphological distribution of red blood cells, white blood cells, platelets, etc.
2. Mycobacterium tuberculosis examination
The most specific method for diagnosing pulmonary tuberculosis is to examine the tuberculosis bacilli. Finding tuberculosis bacteria in sputum is the main basis for confirming pulmonary tuberculosis. Smear examination or bacterial culture is used.
3. Tumor markers
Tumor markers are chemical substances that reflect the presence of tumors. Generally, elevated levels of these marker antigens are clinically associated with the presence of malignant or benign tumors or cancer.
4. Pleural effusion examination
Determining the nature and etiology of the effusion is crucial. The cause of most effusions can be determined through pleural fluid analysis. Thoracentesis is essential if exudate is suspected. However, if transudate is suspected, thoracentesis should be avoided. Even in cases of uncertainty, thoracentesis should be performed. Examination should include appearance and odor, cells, pH and glucose, pathogens, proteins, lipids, enzymes, immunological tests, and tumor markers.
Imaging examinations
1. X-ray
Chest X-ray is the primary imaging method used to detect pleural effusion, and its appearance is related to the amount of effusion and whether there are lumps or adhesions.
2. CT
It can show a small amount of pleural effusion, pulmonary lesions, pleural mesothelioma, intrathoracic and pleural metastatic tumors, mediastinal and paratracheal lymph nodes and other lesions, which is helpful for the diagnosis of the cause.
3. Ultrasound examination
It has high sensitivity and accurate positioning in detecting pleural effusions. It is clinically used to estimate the depth and volume of pleural effusions and assist in thoracentesis positioning.
Pathological examination
Percutaneous closed needle pleural biopsy is of great significance in the diagnosis of the cause of pleural effusion and can detect tumors, tuberculosis and other pleural granulomatous lesions.
Other tests
1. Thoracoscopic or open thoracotomy biopsy
For cases where the above tests are inconclusive, biopsy under direct vision via thoracoscopy or thoracotomy may be performed if necessary. Thoracoscopy has the highest diagnostic rate for the cause of malignant pleural effusions. Thoracoscopy allows for a comprehensive examination of the pleural cavity, observing the morphological characteristics, distribution, and involvement of adjacent organs. Multiple biopsies can be performed under direct vision, resulting in a high diagnostic rate and more accurate clinical tumor staging. In a minority of clinical cases, the cause of pleural effusions remains difficult to determine despite the above tests. In the absence of specific contraindications, exploratory thoracotomy may be considered.
2. Bronchoscopy
This test may be performed on patients with hemoptysis or suspected airway obstruction.
diagnosis
Diagnostic principles
Generally, the presence of pleural effusion can be determined based on symptoms and signs, combined with X-rays, ultrasound, and other examinations. The appearance of the pleural effusion is then used to distinguish between transudates and exudates, further clarifying the cause of the pleural effusion. During the diagnostic process, doctors must differentiate between pleural thickening and other conditions.
Differential diagnosis
Pleural thickening may produce dullness to percussion and decreased breath sounds on auscultation, but is often accompanied by signs such as chest flattening or collapse, narrowing of the intercostal spaces, displacement of the trachea to the affected side, and increased speech conduction. Ultrasound and CT scans can confirm the presence of pleural effusion.
treat
Treatment principles
Patients with pulmonary edema should actively identify the cause of the disease under the guidance of a doctor, and choose appropriate treatment methods based on the cause. If necessary, closed chest drainage can also be performed.
General treatment
1. Rest and nutritional support.
2. Actively treat the primary disease.
Drug treatment
1. Tuberculous pleural effusion
Patients should actively take long-term anti-tuberculosis drugs, including isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin. Glucocorticoids can be added if symptoms of poisoning occur.
2. Pneumonic pleural effusion and empyema
Patients should promptly and appropriately administer antibiotics based on the infecting bacteria to reduce the incidence of parapneumonic pleural effusions and their progression to different stages. Under a doctor’s guidance, patients can also administer fibrinolytic therapy with streptokinase or urokinase, which can thin the pus and facilitate drainage.
3. Malignant pleural effusion
After pleural effusion aspiration or chest tube drainage, intrapleural injection of anti-tumor drugs such as bleomycin, cisplatin, and mitomycin, or pleural adhesion agents such as talc, can slow the production of pleural effusion. Intrapleural injection of biological immunomodulators such as Corynebacterium parvum vaccine, interleukin-2, interferon, lymphokine-activated killer cells, and tumor-infiltrating lymphocytes can inhibit malignant tumor cells, enhance local lymphocyte infiltration and activity, and promote pleural adhesion.
Related drugs
Isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin, streptokinase, urokinase, bleomycin, cisplatin, mitomycin, talc, Corynebacterium parvum vaccine, interleukins, interferons, lymphokine-activated killer cells, tumor-infiltrating lymphocytes
Surgical treatment
1. Thoracentesis
Thoracentesis involves puncturing the pleural space between the lung and chest wall to remove fluid. This fluid can then be analyzed to determine the cause and alleviate symptoms of compression. Clearing the pleural effusion is key to treatment, and as much fluid as possible should be aspirated. Depending on the patient’s condition, repeated aspiration or closed drainage with an intercostal tube may be necessary.
2. Surgery
(1) Patients who develop chronic empyema should consider surgical treatment, such as pleural fibrostomy, thoracoplasty or pleuropulmonary resection.
(2) For patients with malignant pleural effusion who are insensitive to chemotherapy and for whom radiotherapy is not indicated or ineffective, pleural adhesion and chemical pleurodesis may be considered to alleviate symptoms and improve quality of life.
Chemoradiotherapy
Chemotherapy may be considered for some patients with malignant pleural effusions. Mediastinal lymph node radiotherapy may be considered for patients with thoracic duct obstruction and chylothorax that is insensitive to chemotherapy.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, and personal constitution, and may vary from person to person.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
The prognosis of pulmonary effusion is related to factors such as its cause, appropriate and timely treatment, and the severity of the disease. Tuberculous, inflammatory, and cardiogenic pleural effusions generally have a better prognosis, while tumor-related pleural effusions generally have a poorer prognosis.
Hazards
As the disease progresses, complications such as bacterial infection, pleural adhesions, anemia, severe heart failure and renal failure may occur, threatening life safety.
Curative
This disease may be cured with active treatment.
daily
Overview
Family members should give more care and companionship to patients, relieve their negative emotions, and help them overcome the disease; they should take medication on time and in the right dosage, and follow the doctor’s instructions; they should pay attention to rest and engage in appropriate physical activities on a daily basis; after a period of recovery, they should follow the doctor’s instructions for regular check-ups, and seek medical attention at any time if they feel unwell.
Psychological care
1. Psychological characteristics
Due to the pain caused by the disease and the worry about recovery, patients may experience negative emotions such as irritability, anxiety, and depression.
2. Nursing points
(1) Family members should spend more time with the patient and communicate with the patient more often to alleviate or eliminate the patient’s negative emotions and enable the patient to actively cooperate with treatment.
(2) Patients should take the initiative to learn about the disease, communicate with their family members or medical staff, relax, and actively cooperate with treatment.
Medication care
Take medication as directed by your doctor and do not stop taking or change the dosage without authorization.
Life Management
1. Arrange rest and activities reasonably, gradually increase the amount of activity, and avoid excessive fatigue.
2. Create a good living environment, keep the indoor air fresh, and ventilate frequently.
3. Add clothes according to the weather to keep warm and prevent colds.
4. Quit smoking and avoid inhaling secondhand smoke and other irritating gases.
Follow-up Instructions
Follow your doctor’s advice for regular checkups to keep abreast of changes in your condition; if you feel unwell, seek medical attention at any time.
diet
Dietary adjustment
A scientific and reasonable diet can ensure the normal functioning of the body, help control the disease, maintain the treatment effect, and promote recovery from the disease.
Dietary recommendations
It is advisable to eat a diet that is high in energy, high in protein and rich in vitamins.
Dietary taboos
During the recovery period, you should try to avoid eating greasy, spicy and irritating foods.
prevention
Preventive measures
The following can reduce the risk of developing this disease:
1. Pulmonary edema is part of chest or systemic disease, so actively preventing and treating the primary disease is the key to preventing this disease.
2. Actively participate in various appropriate physical exercises, such as Tai Chi, Tai Chi sword, Qigong, etc., to enhance physical fitness and improve disease resistance.
Medical Guide
Outpatient indications
1. Chest pain, cough, and difficulty breathing.
2. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
Patients can go to the respiratory department for treatment, and if surgical treatment is required, they can also go to the thoracic surgery department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
3. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
4. Family members can be arranged to accompany the patient to seek medical treatment.
5. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Are your symptoms persistent or intermittent? Is there a pattern?
4. Have your symptoms gotten worse or better since you became ill? What’s the reason?
5. Have you ever had similar symptoms before?
6. Have you ever received treatment before? How was it treated? What was the effect?
What questions can patients ask?
1. Is my condition serious?
2. Why does this happen to me?
3. What treatment do I need? Do I need to be hospitalized? How long will it take to recover?
4. Are there any risks associated with these treatments?
5. If taking medication, what are the usage, dosage and precautions of the medication?
6. What tests do I need? Are they covered by medical insurance?
7. How should I take care of myself after returning home?
8. Do I need follow-up examinations? How often?