Malignant pleural effusion

Introduction Malignant pleural effusion refers to pleural metastasis of malignant tumors or pleural effusion caused by malignant tumors of the pleura. Infection, pain, and pericardial effusion of cancer are common complications of advanced cancer. The reduction of stress-induced atelectasis, restrictive ventilatory disorder, respiratory failure, and decreased blood volume caused by a large amount of pleural effusion seriously affects the respiratory cycle function and directly threatens the patient's life.

Cause

Malignant pleural effusion is common in advanced lung cancer, with an incidence of up to 60%. And often progressive. The main cause of the disease is the invasion of the pleural metastasis and the obstruction of capillaries and lymphatic vessels. Therefore, the pleural effusion contains a large amount of protein and blood, and bloody pleural effusion accounts for about 75%. Ascites is more common in gynecological tumors, digestive tract tumors and liver cancer, as well as bloody ascites.

an examination

Related inspection

Pleural effusion examination pleural effusion chest CT examination Pap or HE staining examination of fibrin degradation products of pleural and ascites

1, the chest X-ray film for malignant pleural effusion is the most basic examination, the rib angle becomes blunt, suggesting a small amount of fluid. A large amount of pleural effusion is often accompanied by atelectasis and mediastinal shift to the temporal side. If the mediastinum is fixed due to tumor, the mediastinal shift is not obvious. Ultrasound examination is important for determining the content of pleural effusion, whether the pleural effusion is wrapped, knowing the direction of the needle insertion and the depth of the needle.

2, for patients with ascites, CT examination can not only determine the presence of ascites, but also understand the abdominal mass, retroperitoneal lymph node and morphological changes in the abdominal organs. Ultrasound can not only determine the amount of ascites, but also help determine the location of the puncture, the position of the needle and the depth of the needle.

3, bloody chest, ascites are mostly malignant, smear cytology can often find malignant tumor cells. When cytology is not diagnosed, chest and peritoneal biopsy can be performed by thoracoscopy or laparoscopy if necessary, and more than 90% of patients can be diagnosed.

Differential diagnosis

1. Lung cancer pleural effusion: It is a common complication of patients with advanced lung cancer. It may not affect the quality of life at first. However, as the disease progresses, it may cause symptoms such as difficulty in breathing, cough, chest pain, and even worse than the patient. Lung cancer itself. The symptoms of pleural effusion in lung cancer are: the swelling is serious, and the gas is thick and full, and the sputum is full, pink foamy sputum, sitting position, can not lie down, difficulty breathing, visible tri-concavity, patients are extremely painful, have a sense of death, The condition is critical, for the water in the chest, oppressing the lungs.

2, bloody pleural effusion: refers to the appearance of pleural effusion is obvious blood, more than 15% of the leakage and more than 40% of the exudate can be bloody, red blood cell count between 5000 ~ 100000 / l, only 5000 ~ 10000 / l Red blood cells can make the pleural effusion red, and only 1ml of blood can make 500ml pleural effusion bloody, and red blood cells of gross blood pleural effusion >100000/l. Bloody pleural effusions suggest trauma, malignancy or pulmonary embolism.

3, exudative pleural effusion: a variety of causes of exudative, summarized into two categories: one is caused by inflammatory lesions, such as bacterial, viral or fungal infection of the pleura caused by infectious inflammation, leading to pleural effusion, Or due to pulmonary embolism, pancreatitis, connective tissue disease and other non-infectious inflammation caused by pleural effusion; the second type is neoplastic, such as cancer in the long pleural or metastatic invasion of the pleural effusion, can be seen in pleural mesothelioma, Lung cancer, breast cancer, stomach cancer, etc. The cause of leakage pleural effusion can be systemic diseases, such as hypoproteinemia, allergic diseases, or diseases of certain organs, such as congestive heart failure, cirrhosis, hepatic amebiasis, thoracic duct rupture. Wait.

4, leakage (hydraulic chest) pleural effusion: when congestive heart failure, nephrotic syndrome, cirrhosis and other formation of hypoproteinemia leading to decreased colloid osmotic pressure and water retention caused by pleural effusion; any cause of superior vena cava obstruction Chest leaking effusion occurs; part of the disease causing ascites, lymphatic drainage through the diaphragm of the diaphragm causes pleural effusion. Clinical manifestations include cough, chest swelling, shortness of breath and primary disease. The body has a pleural fluid sign. The pleural effusion is non-transparent and relatively dense.

5, tuberculous pleural effusion: tuberculous pleurisy is the body's highly allergic reaction to tuberculosis protein components, for the primary infection of children and adolescents or secondary tuberculosis involving the chest membrane. Clinical onset can be more urgent, but also slowly, with fever, chest pain, dry cough, fatigue, weight loss, loss of appetite, night sweats and other symptoms of tuberculosis. In the stage of dry pleurisy, chest pain is exacerbated by deep breathing and coughing, and pleural friction sounds are important signs. As the amount of pleural effusion increases, the patient gradually feels shortness of breath. The pleural fluid is grassy yellow transparent or the boat is turbid. It is groundy glass. It can be dark yellow turbid after liberation. The relative density of pleural fluid is often above 1.016, and the total number of white blood cells is For 1~2X10/L, the acute phase is mainly neutrophils, while the chronic phase is dominated by lymphocytes, the mesothelial cells are generally less than 1%; the protein content is above 25g/L, and the sugar content is more than 2.8mmol/ Below L; lysozyme and adenylate deaminase in pleural effusion are increased; tuberculosis is easy to find in pleural smear and collecting bacteria, and about one-third of the culture method is positive. For 1/2 cases of pleural biopsy, cheese or non-cheese granulomatous tissue can be seen. When the pleura has inflammatory adhesion, a wrapped pleural effusion can be formed.

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