What Is Malignant Pleural Effusion?

Malignant pleural effusion. In most cases, malignant tumor cells can be found in pleural effusion. If pleural effusion is accompanied by metastatic nodules on the surface of the pleura or pleura, no matter whether malignant tumor cells can be found in pleural effusion, the malignancy can be diagnosed Pleural effusion. Approximately 40% of the large amounts of pleural effusion seen clinically are caused by malignant tumors, the most common being lung cancer, breast cancer, and lymphoma. There are certain differences in the types of tumors between men and women. Men are most commonly lung cancer, lymphoma, and gastrointestinal tumors; women are most commonly breast cancer, female reproductive tract tumors, lung cancer, and lymphoma.

Basic Information

English name: malignant pleural effusion
Visiting department: Surgery; oncology
Common locations: Thoracic cavity

Common causes: Pleural metastatic tumor, diffuse pleural mesothelioma
Common symptoms: Weight loss, weight loss, fatigue, anemia, progressive increase in dyspnea, chest pain, dry cough, etc.

Etiology of malignant pleural effusion

Malignant pleural effusion accounts for 38% to 53% of all pleural effusions. Among them, pleural metastatic tumors and diffuse pleural mesothelioma are the main causes of malignant pleural effusions.

Clinical manifestations of malignant pleural effusion

Most patients have cachexia manifestations of advanced tumors, such as weight loss, weight loss, fatigue, and anemia. Patients present with progressively worsening dyspnea, chest pain, and dry cough. The degree of dyspnea is related to the amount of pleural effusion, the speed of pleural fluid formation and the patient's own lung function. When the volume of effusion is small or the formation speed is slow, the clinical dyspnea is lighter, such as chest tightness and shortness of breath. If the amount of fluid accumulated in the lungs is significantly compressed, breathing difficulties will increase clinically, and even sitting breathing and cyanosis will occur. Patients with a large amount of pleural effusion prefer to take the affected side in a supine position, which can reduce the breathing movement on the affected side, which is conducive to compensatory breathing of the healthy side lungs and relieves breathing difficulties. Tumor invasion of the pleura, pleural inflammation, and wall pleural distension caused by a large amount of pleural effusion can cause chest pain, mostly persistent chest pain; pain in the palatal pleura invades the affected scapula when it invades. Cough is mostly irritating dry cough, which is caused by pleural effusion stimulating the bronchial wall. During the physical examination, it was found that the respiratory movement on the affected side was weakened, the intercostal space was full, the trachea was shifted to the healthy side, and the percussion in the effusion area was dull, and the breathing sounds disappeared.

Malignant pleural effusion

Chest x-ray

The costal ridge angle becomes dull when there is a small amount of effusion; the middle and lower parts of the lung field show a dense and uniform shadow with a small amount of effusion, and the depression is high outside and inside the upper edge; . The hypothalamic effusion appeared in the subpulmonary fluid, and the lateral or horizontal lying position can be confirmed. When the effusion is wrapped between the leaves, there are approximately round and oval shadows in different parts of the pleural cavity or between the leaves. The side film can determine the location.

2. Pleural effusion examination

According to color, traits, specific gravity, qualitative test of mucin, classification of cell counts, smear to check pathogenic bacteria, sugar, protein determination, etc. can be initially judged to be exudate. Specific gravity> 1.018, white blood cell count> 100 × 10 ⁶ , protein quantitative 30g / l, protein quantitative / serum protein quantitative> 0.5, lactate dehydrogenase / serum lactate dehydrogenase> 0.6, lactic dehydrogenase amount> 200u / l Exudate. In patients with malignant pleural effusion, about 60% of the patients can detect cancer cells in the first test specimens. If three consecutive samples are taken, the positive rate can reach 90%. It should be noted that pleural effusion cytology in patients with lymphoma is not reliable.

3. Ultrasonic exploration

The puncture site can be selected more accurately, which is helpful for diagnosis and differential diagnosis.

4. Pleural biopsy

Pleural biopsy is feasible when it is difficult to make a clear diagnosis through the above-mentioned various examinations. Cancer often involves local pleura. The positive rate of pleural biopsy is about 46%. Pleural fluid cytology combined with pleural biopsy can make the positive rate reach 60% to 90%.

5.CT, MRI examination

It has diagnostic value for pleural effusion caused by pleural mesothelioma.

Diagnosis of malignant pleural effusion

It is clear that pleural effusion occurs in the course of patients with metastatic cancer. This disease should be considered first, and the primary tumor should be treated. When pleural effusion occurs in patients without malignant tumors, heart failure and tuberculosis should be excluded first. Primary pleural effusion, pleural puncture, and biochemical analysis of pleural effusion and tumor cell examination, or pleural biopsy, can usually confirm the diagnosis.

Treatment of malignant pleural effusion

Cause treatment

Actively treat primary disease.

2. Eliminate effusion

A small amount of effusion can be naturally absorbed without treatment. If the effusion is more than a moderate amount, it has compression symptoms, and the effusion should be performed to extract the effusion 2 to 3 times a week. The amount of fluid should not be too much or too fast to prevent pleural shock and ipsilateral dilated pulmonary edema.

3. Drug injection

Cancerous pleurisy can be injected with anti-cancer drugs, or tetracycline can be injected after complete drainage, which produces chemical stimulation and adhesions to reduce the symptoms of compression caused by the excessive growth of malignant pleural effusion.

4.Pleural cavity intubation and drainage

When the repeated aspiration of malignant pleural effusion is not good, a thin catheter can be inserted for closed drainage. After about 72 hours of complete drainage, the above drugs are injected.

5. Surgery

Patients who have failed conservative treatment can consider surgical treatment and pleural adhesion.