SUNDAY MAGAZINE

Trouble around the lungs

DR. R. NARASIMHAN

Answers to frequently asked questions about pleurisy.

Some time back a television news channel called me for a live show to talk or dispel doubts on pleurisy. The kind of questions asked were interesting and it seemed worthwhile to spread awareness of this disease.

What is pleura?Pleura is a membrane that covers the lungs and the inner wall of the chest; visceral and parietal pleura respectively. In normal breathing, they slide over each other without any friction.

What is pleurisy?It is a condition where the pleurae are inflamed and cause pain due to friction during breathing.

What are the symptoms of pleurisy?The main symptom is sudden, intense chest pain usually located over the area of inflammation. Although the pain can be constant, it is usually most severe when the lungs move during breathing, coughing, sneezing, or even talking. The pain is usually described as shooting or stabbing but, in minor cases, it resembles a mild cramp. When pleurisy occurs in certain locations, such as near the diaphragm, the pain may be felt in other areas such as the neck, shoulder, or abdomen (referred pain). Another indication is that holding one’s breath or exerting pressure against the chest causes pain relief.

Do patients have breathing difficulty?Yes. Pleurisy is also characterised by certain respiratory symptoms. In response to the pain, patients commonly have a rapid, shallow breathing pattern. Sometimes fluid accumulation can occur. This is called pleural effusion.

What happens in pleural effusion?In pleural effusion fluid accumulates between both pleurae. When this occurs pain disappears but respiratory difficulty on exertion occurs. In early stages it is not noticeable while walking on plains but becomes manifest when they climb stairs and run to catch a bus. Disappearance of chest pain should not make one complacent. Be careful enough to observe if they are getting breathless on slight exertion. This should alert them to see a physician.

What kinds of fluid can accumulate in the pleural cavity?Fluid accumulation can range from simple fluid, pus, blood, lymph and, sometimes, faecal matter and urine if there is an accident and multiple organs are involved.

How can pleural effusion be diagnosed?The symptoms of chest pain and respiratory difficulty are too classic to be missed. A chest x-ray can easily diagnose effusion.

What are the causes of pleural effusion?It could be due to infections like TB, pneumonia or cancers. Pleural effusion can also occur in heart failure, liver diseases and kidney diseases where improper diet and decrease in protein are the causes. In fact they are bigger causes of pleural effusion.

Are there any tests to diagnose the cause of pleural effusion?The fluid in the chest can be removed by a procedure called aspiration. In this a needle is introduced through the skin under local anaesthesia, fluid is withdrawn and sent for bacteriological and pathological tests. This test can be done under the guidance of a radiologist, as he can guide the needle exactly to the point where fluid is located. The tests and the markers are to be decided by your physician.

Can effusion occur in people who smoke?People who smoke are prone to lung cancer and when cancer involves pleura, effusion occurs making the cancer slightly advanced.

Which is the best way to confirm the cause of effusion?The confirmatory test is pleural biopsy, which can be done by a needle or thoracoscopy.These small pieces of pleural tissue is sent for a pathological examination that will confirm the diagnosis.

What is pleuroscopy?Some times the needle biopsy may not yield the diagnosis. In such cases pleuroscopy can be used. It is a fibre-optic instrument that is passed into the chest and the whole pleural cavity can be visualised in a monitor, biopsies can be taken under vision. In this procedure the diagnosis can be obtained with greater accuracy.

Can all the fluid be removed?All the fluid is removed only during respiratory difficulty or when it is accumulating rapidly. This occurs more often in cancers. A tube is then kept in the chest cavity to prevent the rapid expansion of the lung. In cancer after complete expansion a chemical or talc powder is introduced to seal the chest cavity to prevent further accumulation.

The writer is a Chennai-based Senior Respiratory Physician. E-mail >drrnarasimhan@yahoo.co.in

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