The pleura are the two moist membranes that surround the lungs, forming a double layer. The inner layer is attached to the lungs. The outer layer is attached to the ribs.What is pleural effusion?
A pleural effusion is a collection of fluid in the chest cavity around the lungs, due to a variety of reasons. This fluid can compress the lung tissue, resulting in shortness of breath that often requires oxygen therapy.What is empyema?
Empyema (or empyema thoracis) is a category of pleural effusion. Empyema is a collection of fluid within the pleural cavity (membranous covering of the lung). It usually occurs due to the extension of pneumonia in the adjacent lung segment or lobe. It starts out as a thin, clear, serous effusion which later becomes infected and thick in consistency.What are the symptoms of pleural effusion and empyema?
Some types of pleural effusion don’t cause symptoms. Other types cause symptoms that include the following:
- Shortness of breath
- Chest pain
- Stomach discomfort
- Cough, coughing up bloodand shallow breathing
- Rapid pulse or breathing rate
- Weight loss
- Fever, chills or sweating
During a physical exam, your doctor may listen to or tap your chest. He or she may request the following tests:
Chest X-ray: To take a picture of the structures inside the chest
Ultrasound: A test that uses sound waves to find or examine structures inside the chest
CT scan: X-rays and computer technology combine to make pictures of structures in the chest
Thoracentesis: A fluid sample is taken from the pleural space (the area between the two layers of membrane surrounding the lungs) using a needle
Thoracoscopy: A thorascope—an instrument with a tiny camera—inserted into the chest lets the doctor view your entire chest space on a monitor. The fluid is drained and the physician can also perform a biopsy if necessary.
Treatment for pleural effusion and empyema will depend on underlying cause of the disorder, but may involve insertion of a tube to drain the fluid, which typically relieves the symptoms. Medical management may be necessary.
MINIMALLY INVASIVE AND OPEN SURGERY
Definitive treatment involves an operation where 2-3 small incisions are made in the side of the chest and a fiber optic camera (thoracoscope) is inserted. The chest is inspected for signs of abnormal growths either on the lung or on the inner surface of the chest well. The fluid is drained, all loculations (pockets of pleural fluid) broken up, and talc powder is instilled in the chest. This causes an inflammatory reaction which scars the lung against the chest wall, preventing the re-accumulation of fluid. This operation is approximately 75% successful in preventing recurrence of the fluid collection, but does not treat the underling cause of the effusion. Another good option in patients with trapped lung (lungs that do not expand due to severe cancer or scar tissue involvement) is placement of a pleurex catheter.
With free flowing fluid, chest tube drainage along with antibiotic use provides optimum resolution, however with thickening and formation of loculations, chest tube drainage becomes inadequate and surgical drainage with VATS surgery is required for complete drainage. If drainage is delayed, VATS may not achieve complete decortication (removal of the infected peel covering the lung) and a conventional open thoracic surgical procedure (thoracotomy) with decortication is required. VATS drainage is a highly successful procedure with cure rates at 90-95%.