Introduction
If there is an accumulation of fluid in the lungs, this is a serious clinical picture that must be clarified urgently. Small amounts of fluid in the lungs are usually not noticed by the patient. Only when there is a larger amount of water or fluid does the patient become symptomatic. As a rule, the patient becomes breathless and has a dry cough.
Causes
One of the most common causes of water in the lungs is cardiac insufficiency (heart failure). When the heart is so weakened for various reasons that it can no longer move blood back and forth in the body sufficiently, a backwater builds up that reaches the lungs. Slowed blood causes fluid to be distributed and accumulate in the surrounding space.
Pressure-induced pulmonary oedema is less common but just as dangerous. In this case, low air pressure (e.g. in mountaineering) causes fluid to be pressed out into the lung space, which is otherwise filled with air. In the broadest sense, water in the lungs is also water in the so-called pleural effusion, i.e. water located at the edges of the lungs.
Most often, inflammatory processes are involved here or a severe protein deficiency in the body. A frequent cause of water in the lung is severe pneumonia or a malignant tumor in the lung. A pulmonary embolism, i.e. an infarction of the lung due to a blood clot, can also cause water to accumulate in the lungs.
The same applies to tuberculosis, which has become rare today. The causes listed are explained in more detail below:
- Heart attack
- Cancer diseases
- Chemotherapy
- Pneumonia
- Operations
- Alcohol
During a heart attack, the heart muscles are damaged due to a lack of blood circulation. The damage limits the pumping ability of the heart chambers.
Most heart attacks occur in the left ventricle. Blood flows from the lungs into the left ventricle and is then pumped throughout the body. Due to the limited pumpability, the heart is no longer able to pump as much blood into the body as before.
The blood, which can no longer enter the body’s circulation, accumulates back into the lungs. As a result, the pressure in the pulmonary vessels increases and more fluid is forced into the lung tissue. This results in pulmonary edema (water in the lungs).
Pulmonary edema is an acute condition that occurs during a heart attack and causes breathing difficulties. During therapy, the pulmonary edema subsides. The damage to the heart muscles heals to form a scar.
Depending on the size of this scar, there may still be limitations to the heart’s pumping ability. Similar topics that might interest you: Life expectancy with water in the lungsIn cancerous diseases, especially those with advanced findings, water accumulates, mostly in the bilateral pleural gaps. More rarely, pulmonary edema, i.e. water accumulation directly in the lungs, occurs.
There are many reasons why pleural effusions occur in cancerous diseases. As a rule, in lung cancer, for example, the lung can no longer expand and collapse in the usual way. In a healthy person, this process enables good and even ventilation of the lungs.
If parts of the lung are no longer ventilated due to a tumor, there is an influx of fluid in these areas, initially in very small quantities that are not noticed by the patient, but later in larger quantities, severe discomfort and even breathing difficulties can occur. Another cause of water in the lung or pleural gap in cancerous diseases is the smallest inflammatory changes in the area of the lung and the pleural gap. Inflammation also always means inflammatory fluid, so-called exudate.
If it accumulates in large quantities, it can cause breathing difficulties. Further causes are drainage disorders of the lymphatic fluid. The lymph vessel system runs through the entire body.
It serves the immune system and prevents pathogens from entering the body. Numerous lymph vessels also pass through the lungs. If a mass, such as a tumor, spreads in the body, it can also press on a lymph vessel and cause congestion.
This congestion becomes noticeable by the lymph fluid escaping into the surrounding tissue.Often aggravating factors are the imbalance of proteins and electrolytes in cancer patients, which also favours an influx of water into the lungs or pleural gap. In the case of lung tumors, the lung cannot be moved to the usual extent, which also leads to a mostly inflammatory edema in the area of the lung borders. In the X-ray image, a pleural effusion can be recognized by a brightening of the otherwise deep black areas at the outermost deep-lying areas on both sides of the lung.
Sometimes, usually with large amounts of fluid, a pleural effusion can also be detected by an ultrasound scan. Larger pleural effusions must be punctured. Alternatively, a drainage tablet can be given to the patient to make him excrete more water.
In general, however, the triggering factors must be eliminated and appropriate diagnostics must be performed. If metastases form in the lungs – regardless of whether they originate from lung cancer or from another organ, e.g. the breast – water retention occurs. This leads to the formation of pulmonary edema.
In most cases, the metastases initially cause no symptoms for a long time and the lung edema is not very pronounced. For this reason, metastases are often only detected in an X-ray. Like the metastases, lung cancer itself leads to water retention and thus to lung edema.
Advanced metastases also lead to other symptoms that also occur in lung cancer. These include coughing with bloody sputum, difficulty breathing, persistent hoarseness and chest pain. In general, weight loss also occurs.
This topic might also be of interest to you: Metastasis in breast cancer Chemotherapy is a great burden on the body. The toxins of chemotherapy, which are supposed to successfully fight cancer, also attack healthy cells in the body. This leads to numerous side effects.
How well a chemotherapy is tolerated varies greatly from individual to individual. The different chemotherapeutic drugs have different effects on the lungs. Many lead to a permanent inflammation of the lungs.
In the case of inflammation, water often collects between the lungs and the chest wall. This is called a pleural effusion. A pronounced pleural effusion leads to breathing difficulties.
There are also chemotherapeutic drugs that typically cause pulmonary edema. These include methotrexate. Methotrexate is a frequently used drug.
For example, it is used to treat breast cancer and acute leukemias. These topics may also be of interest to you:
- Side effects of chemotherapeutics
- Side effects of Methotrexate
Pneumonia is usually caused by viruses from the air we breathe, in some rare cases also by bacteria. Within a few hours or days an inflammatory process in the lung area occurs.
The pathogens attach themselves to the sensitive mucous membrane epithelium of the lung. The body then begins an immune reaction to defend itself, which includes an inflammatory change in the epithelium. The purpose is to get the pathogen out of the body as quickly as possible.
The inflammation ensures that the gas exchange is reduced at the appropriate point in the lung and that a film of mucus is formed as a kind of protection. The patient initially notices nothing of the reduced gas exchange, as the other areas of the lung take over. However, the increasing amount of viscous mucus increasingly causes the patient to develop a cough, which is intended to transport the mucus with the pathogens outside.
In addition to the production of inflammatory mucus, the body also allows cells to migrate into the body, which change the temperature setting in the body. This leads to an increase in fever. In contrast to a lung tumor, lung inflammation causes an increased number of inflammatory temporary changes in the lung tissue.
The longer and more persistent a pneumonia is, the more the air-filled space in the lungs fills with mucus. In X-rays, this condensation can be seen by a strong brightening in the affected area. When listening to the lungs, one hears increased breathing sounds.
In this area, air can hardly enter the bloodstream because it is prevented from doing so by the mucus coat. In this situation, the patient will also feel increasing shortness of breath in addition to the fever and the increasingly strong cough.Where not enough air can be exchanged and the brakes are applied, the accumulation of fluid can also increase. Water in the lungs as a result of pneumonia, however, only occurs with very severe and not timely treatment.
Pleural effusions can occur in any case. These are signs of the inflammatory process and restricted movement of the lungs. Water accumulation in the lungs after an operation usually only occurs after major surgery.
Often, pulmonary edema occurs after heart surgery, for example. In most cases, the water in the lungs after surgery is harmless and quickly recedes. As a rule, even small amounts of fluid are involved, which are not noticed by the patient.
There are various reasons for water accumulation in the lungs after an operation. After a major operation, the body needs time to adjust. In addition, operations are a strain on the heart and kidneys.
Patients who have previous heart or kidney diseases are particularly susceptible to pulmonary edema. As a result of heart failure, i.e. insufficient pumping capacity of the heart, the blood backs up in the lungs and water is forced into the lung tissue from the blood vessels. In renal failure, the kidneys can no longer filter enough water from the body.
The excess water is deposited in the tissue. The lung is susceptible to this, as it is usually located at the bottom during an operation, so that the water collects there due to gravity. Massive accumulations of water in the lungs can occur in the event of multiorgan failure.
In this case, the body is completely overwhelmed by the strain. Among other things, the kidneys are no longer able to transport water from the body. Multi-organ failure can occur in very large operations and very sick patients.
Chronic alcohol consumption sooner or later leads to reduced liver function. Among other things, the liver has detoxifying functions and also ensures that the body is supplied with sufficient proteins. Prolonged and harmful alcohol consumption initially leads to fatty liver, and later to cirrhosis of the liver.
At the latest then the liver can no longer work in the usual way, which means that toxins can no longer be transported out of the body, but also that albumin is no longer present in the body in the usual quantity. In addition, there is a backlog of blood from the liver, which leads to so-called ascites (abdominal fluid). The abdominal fluid is nothing more than fluid that has been filtered out of the blood, i.e. pressed out of the blood by backwater processes, and which accumulates in the surrounding tissue.
In the majority of cases, the water accumulates around the liver, which causes the abdomen to swell and creates increased pressure on the abdominal cavity. In some, but rather rare, cases, these congestion processes and the reduced amount of protein also cause water to accumulate in the lungs, which can lead to the typical symptoms, such as coughing (initially on exertion and then at rest) and shortness of breath. There are some medications that can be used to try to get the abdominal fluid and water out of the lungs.
In addition to the flushing effect, these drugs also lead to a reduction of pressure in the body. In cases where the medication does not work or where the water is already present in too large quantities, the fluid must be punctured. In principle, the triggering causes must also be remedied here. Otherwise, the water will come back very quickly, whether in the lungs or abdomen.
