In normal people, there is a small amount of fluid in the pleural cavity, which plays a lubricating role in respiratory movements. When there is a large increase of fluid in the pleural cavity, it is called pleural effusion.
Pleural effusion can be divided into leakage and exudate, benign and malignant, and also bloody, purulent and celiac according to its nature. At present, the more common ones are mostly pleural effusions caused by infections (especially tuberculous pleurisy is the most common) and malignant tumors. Most benign pleural effusions are pale yellow clear pleural fluid, similar to beer-like. Most malignant pleural effusions are hemorrhagic pleural fluid.
A small amount of effusion (<300ml) is usually asymptomatic. When the amount of fluid accumulation >500ml, the angle of rib diaphragm is blurred and blunted as seen on X-ray. Above medium amount, patients may feel chest tightness and dyspnea, and arc-shaped shadow is visible on x-ray. Ultrasonography is more reliable for locating pleural effusion and determining the depth of needle entry during thoracentesis.
The differential diagnosis of pleural effusion is mainly the extraction of pleural fluid for examination and the examination of the primary lesions in the chest and lungs.
In addition to active treatment of the primary lesion, pleural aspiration, closed drainage of the chest cavity, thoracoscopic biopsy and pleural fixation can be used for pleural effusion, and for patients with chronic prolongation and formation of encapsulated abscess chest, pleurodesis is also required.
The following is a brief explanation of some frequently asked questions.
What are the methods of pleural fluid extraction? Can it be done on an outpatient basis?
The main method of pleural fluid extraction is thoracentesis, which can be performed on an outpatient basis, but it is relatively safer to operate in an inpatient setting. For patients with abscess chest, malignant pleural fluid and combined pneumothorax, closed chest drainage may be required. For patients whose diagnosis is unclear and requires pleural biopsy, pleural fluid can be aspirated while performing thoracoscopy to reduce the occurrence of pleural adhesions or even encapsulated pneumothorax.
Is it painful to aspirate pleural fluid? What complications can occur?
Thoracentesis aspiration is a local anesthetic, which is generally painless and relatively safe for thoracic surgeons as it is the most common minor operation.
Complications are mainly as follows
1, peripheral tissue injury: pneumothorax, hemorrhage, transverse septum and abdominal organ injury.
2, pleural reactive shock.
3, infection of the chest cavity.
4, protein loss.
5, electrolyte disturbances.
6, pulmonary edema with pulmonary resuscitation.
7, pleural fluid embolism.
How much pleural fluid should be pumped at a time?
The first time the pleural fluid is pumped no more than 600-800ml, and each time thereafter no more than 1000ml, it can be pumped 2-3 times a week, which can be increased appropriately if a slow release device is used. In the case of thoracoscopic surgery, because the chest cavity is open, gas can enter quickly to avoid too rapid lung reopening, and basically, there is no limit to the amount of fluid that can be pumped, and the majority of the pleural fluid can be aspirated.
What symptoms can occur during the process of chest fluid aspiration? How to deal with it?
If dizziness, panic, cold sweat, pallor, chest tightness, chest pain, violent cough, or difficulty in breathing occur, stop the operation immediately. Let the patient lie flat, administer oxygen, and give further resuscitation treatment according to the situation.
Is it normal to have blood in the chest water after pleural effusion puncture?
During the puncture process, the chest wall may be damaged and it is normal to have slight blood in the pleural fluid, which usually does not require special treatment. After puncture, the patient’s blood pressure and general condition should be observed, and serious bleeding should be detected and treated in a timely manner. Sometimes the first clear and yellowish pleural fluid will turn into light bloody pleural fluid when the pleural fluid is drawn for the second time.
In which patients is closed chest drainage indicated? What are the contraindications?
Applicable to: spontaneous, traumatic, secondary pneumothorax, acute and chronic abscess chest, pneumothorax, malignant effusion.
Contraindications.
1.Leakage of fluid.
2.Patients with poor general condition and cardiopulmonary insufficiency. (However, cardiopulmonary insufficiency due to massive pleural effusion should be decided on a case-by-case basis.)
What are the precautions to prevent infection?
When operating, strictly follow the principles of aseptic operation.