Pleural cavity effusion

Involves removal of fluid in the pleural cavity via a needle. The fluid then is assayed for presence cancerous cells. This procedure has low sensitivity and depends on the presence of a pleural effusion... 

Of 51 patients with malignant pleural effusions, 14 underwent slurry talc pleurodesis via a chest tube, 14 had talc poudrage during Video-Assisted Thoracoscopic exploration of the pleural cavity for suspected malignant effusion, and 24 underwent chemical pleurodesis with bleomycin via a chest tube (16). The most common adverse effects were chest pain and fever. The duration of adverse effects after talc pleurodesis was longer (2-3 days) than after bleomycin. There was chest pain in 15 of the 28 patients who received talc, with a duration of 18-52 (median 31) hours. There was fever in 22 of those who received talc, with a duration of 5-34 (median 12.5) hours. Complications were more common in those who received talc, such as thoracic empyema n — 1), wound infection n — 2), and respiratory distress n — 5). 

The pleural, pericardial, and peritoneal cavities normally contain a small amount of serous fluid that lubricates the opposing parietal and visceral membrane surfaces. Inflammation or infections affecting the cavities cause fluid to accumulate. The fluid may be removed to determine if it is an effusion or an exudate, a distinction made possible by protein or enzyme analysis. The collection procedure is called paracentesis. When specifically apphed to the pleural cavity, the procedure is a thoracentesis if applied to the pericardial cavity, a pericardiocentesis. Paracenteses shordd be performed only by sldlled and experienced physicians. Pericardiocentesis has now been largely supplanted by echocardiography. 

Intracostal pimction and insertion of a cannula into the pleural cavity is mostly used to induce pleurodesis and thereby reduce pleural effusions. Intrapleural administration of sclerosing agents such as sterile talcum powder, doxycycline or bleomycin destroy the meso-thelial cell layer and incite pleuritis, adhesions, and destruction of the pleural space. 

Signs and Symptoms Pneumonia with or without bacteremia. Pulmonary abscesses, fluid (pleural effusion) and pus (empyema) in the chest cavity may occur. In acute cases pus is discharged from the nose. There are ulcers in the mucous membranes of the nose and possibly the pharynx. 

Intracavitary administration of various agents has been used for patients with malignant pleural or peritoneal effusions. Intraperitoneal instillations of cisplatin, etoposide, bleomycin, 5-fluorouracil, and interferon are well tolerated and are being evaluated in patients with ovarian carcinomas, in whom the tumor is frequently restricted to the peritoneal cavity. 

OHSS is characterized by cystic ovarian enlargement, increased capillary permeability, and third space fluid accumulation (that is in an extracellular compartment that is not in equilibrium with either the extracellular or intracellular fluid, for example the bowel lumen, subcutaneous tissues, retroperitoneal space, or peritoneal cavity). Risk factors include a previous history of OHSS, age under 30 years (probably because more follicles are available), and polycystic ovary syndrome. Non-pregnant patients usually recover within 14 days with supportive treatment. The severe form (with ascites or pleural effusion and hemoconcentration) occurs in 1-10% of patients (64,65). In critical cases, hypoxemia, renal insufficiency, thromboembolism, and rarely death can occur (66). 

Pleural effusion Cells (fluid) can ooze or weep from the lung tissue into the space between the lungs and the chest cavity (pleural space) causing a pleural effusion. The effusion fluid may be clear or bloody. Pleural effusions may be an early sign of asbestos exposure or mesothelioma and should be evaluated. 

Radiographic features tend to be quite variable hilar adenopathy with alveolar infiltrates, tissue excavation of an infiltrate (resulting in a thin-walled cavity), or small pleural effusions are all seen commonly. With chronic persistent pneumonia, chest radiographs usually demonstrate apical fibronodular lesions or slowly progressive cavitation. 

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