In this article the attention will be focused on the symptoms caused by the pleural effusion, on the diagnostic techniques useful for the assessment of the affection and on the therapeutic strategies aimed at its cure.
. This disorder seems to originate from the co-presence of several mechanical factors: depression of the ipsilateral diaphragm, depression of the pleural space, depression of the mediastinum and of the lung.
The classic symptoms that accompany pleural effusion can be summarized as follows:
- Dyspnea (hunger for air, difficulty in breathing)
- Chest pain
- Dry / irritating cough
Chest pain is often described as stabbing, tending to exacerbate during breathing.
Hypoxia, hypercapnia and tachypnea constitute a triad of signs that often come close to those just described, although less frequently.
In addition to these prodromes, the patient with pleural effusion can clearly also complain of symptoms related to a possible underlying disease. For example, some patients report abnormal chest pain, fever, ascites, rapid breathing, shortness of breath, hiccups, anemia and decrease in body weight Only rarely does pleural effusion proceed in a completely asymptomatic manner.
When the pleural effusion is not adequately treated, the symptomatological picture can become complicated, and the patient can suffer even permanent lung damage. Again, infected pleural fluid (empyema) can turn into an abscess, and the pleural effusion itself can induce pneumothorax.
- sustained in particular by anaerobes - is very high: in this case we speak of empyema.
To speak of actual pleural effusion, the amount of fluid accumulated in the pleural cavity must reach at least 300-500 ml.
The most used DIAGNOSTIC TESTS to ascertain a pleural effusion are:
- Chest CT scan: useful for identifying triggering causes. This diagnostic test is also used as a guide to place the catheter in the pleural cavity.
- Chest X-ray
- Analysis of the pleural fluid
- Thoracentesis: diagnostic examination that involves the analysis of a sample of pleural fluid taken by means of a needle inserted directly into the pleural cavity. This examination - carried out under local anesthesia - allows to distinguish an exudative from a transudative effusion.
Please note
Although thoracentesis constitutes an excellent diagnostic test, it is necessary to remember the risks that can follow from repeated similar analyzes: pneumothorax and empyema are the most common complications.
As an alternative to thoracentesis, for the most sensitive patients it is conceivable to opt for a small pleural drainage, useful for both diagnostic and therapeutic purposes.
- Ultrasound: diagnostic test useful for locating pleural micro-passages and acting as an eventual guide for thoracentesis maneuvers
- CT-guided biopsy (useful in case of identifiable lesions)
- Videothoracoscopy
- Spirometry: typical diagnostic investigation used for respiratory function tests. Spirometry is also indicated to analyze the possible functional repercussions of a pleural effusion.
In mild cases (scarce pleural effusion, of the transudative type), it is advisable to proceed with symptomatic treatment; eventually it is possible to subject the patient to oxygen therapy, also administering diuretics.
In the event that the pleural effusion is caused by bacterial insults, it is recommended to administer antibiotics with a broad spectrum of action (penicillins, cephalosporins, etc.) or to follow a targeted antibiotic therapy (in case of isolation of the pathogen). The removal of the pathogen will consequently also produce the healing of the pleural effusion and the restoration of health of the affected patient.
See Also: Pleural Effusion Drugs:
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