Polyplasmatic effusion is a common clinical phenomenon in which patients develop pleural effusion, ascites, and pericardial effusion simultaneously or sequentially during the course of the disease. The mechanisms of their occurrence are the following.
1, direct diffusion and invasion of the infecting pathogen to the plasma membrane
2, increased metaplasia of the organism, resulting in plasma exudation
3, impaired lymphatic drainage.4 Infectious agents spread to the plasma membrane via lymphatic or hematologic dissemination.
The most common causes of multiplasmic effusion are: malignant neoplasm (31.3%) followed by connective tissue disease, tuberculosis, cirrhosis, cardiac insufficiency, etc.
The relationship between the site of effusion and the etiology:When pleural effusion combined with ascites or pericardial effusion, the proportion of malignant effusion is high, accounting for about 81.5% of all malignant effusions. When malignant tumor causes pleural effusion combined with ascites, the primary tumor is mostly from ovary, liver and other digestive organs, and the possibility of lung cancer is very small at this time. For patients with pleural effusion combined with pericardial effusion, special attention should be paid to lung cancer, and hematologic malignancies should also be considered, while ovarian cancer and digestive malignancies are not very likely at this time. The etiology of triple plasma cavity effusion is complex, with benign lesions accounting for 71%, connective tissue disease for 22.6%, and malignant effusion for 16.1%, followed by constrictive pericarditis and cardiac insufficiency. Tuberculous effusions are more common in cases of pleural effusion combined with ascites and pleural effusion combined with pericardial effusion; cirrhosis is almost exclusively seen in cases of pleural effusion combined with ascites; connective tissue disease is more common in all four combinations of multiplasmas, especially in the three types of plasma effusions.
Malignant tumors: The main malignant tumors that cause multiplasmatic effusion are ovarian cancer, lung cancer, liver cancer and other gastrointestinal tract tumors.
The main characteristics of tuberculous effusion are.
(1) Younger age of onset.
(2) having systemic toxic symptoms such as malaise, afternoon hypothermia, wasting, night sweats, etc., and strong positive PPD test.
(3) A history of close contact with tuberculosis, positive TB-PCR for effusion, and effective anti-tuberculosis treatment.
(4) Patients with epithelial cells, multinucleated giant cells or caseous granuloma found by pleural or peritoneal biopsy or surgical exploration pathology.
(5) Repeatedly and repeatedly sputum or effusion looking for antacid bacilli or effusion cultured with branching bacilli
(6) those with pain at the site of effusion
(7) Significant increase in blood sedimentation.
(8) Exudate.
(9) Yellow effusion.
(10) Anti-TB and local injection of hormones and anti-TB drugs are effective.
Connective tissue diseases: multiplasmic effusions caused by connective tissue diseases are mostly inflammatory exudates caused by lesions involving the pleural and pericardial wall layers, mostly exudates, a few are hemorrhagic. The cellular classification is predominantly lymphocytic. The main features: long-term irregular fever, varying degrees of skin, joint and visceral damage, recurrent disease, alternating between remission and recurrence, increased blood sedimentation, increased immunoglobulin, positive antinuclear antibody, antibiotic treatment is particularly effective, while glucocorticoid treatment relieves.
Cirrhosis: cirrhosis mostly leads to portal hypertension, with massive ascites as the main manifestation. Hepatic pleural fluid is mostly seen in the right side of the chest cavity, which is caused by the inhalation of ascites into the chest cavity through the mediastinal fissure due to negative pressure attraction of the chest cavity during breathing. Because ascites is a manifestation of cirrhosis, patients mostly have liver function impairment and portal hypertension, jaundice, spider hemorrhoids, peribulbar varices, gastrointestinal bleeding and other symptoms, and in severe cases, secondary infection and hepatic encephalopathy and other symptoms.
Cardiac insufficiency: Patients are usually older, have a history of heart disease, and often show bilateral pleural effusion mainly on the right side, and the effusion is alternating between exudate fluid and leaky fluid. Cardiac insufficiency is divided into left heart insufficiency and right heart insufficiency, and cardiac insufficiency on one side often causes cardiac insufficiency on the other side and leads to total cardiac insufficiency. Left heart insufficiency is manifested as: pulmonary circulation stasis, pleural effusion, patients often show chest tightness, shortness of breath, coughing, coughing pink foam sputum, sitting breathing, etc. Right heart insufficiency manifests as: body circulation stasis, liver, kidney, large omentum stasis, resulting in liver and kidney insufficiency, decreased intestinal motility, and portal hypertension. It mostly manifests as ascites.
There are also multiple plasma cavity effusions due to filariasis, Mycoplasma pneumoniae, and Chlamydia pneumoniae infections. The effusions caused by filariasis are usually celiac (trauma and tumor-induced injury to the thoracic duct and celiac pond need to be excluded), and mycoplasma pneumoniae and chlamydia can be identified by drawing pleural fluid for relevant antibody tests.