Therapy
The therapy is primarily directed at the triggering underlying disease, such as the tumor disease. In addition, physical therapy can be applied in the form of respiratory gymnastics, heat radiation or chest wraps to increase the patient’s well-being. A pleural puncture can also be used for therapy, which is already applied in the diagnostic process.
This is mainly done when the underlying disease of pleural effusion cannot be treated and when the accumulation of fluid leads to severe shortness of breath, which in extreme cases occurs at rest. As a rule, fluid quantities of between 500 ml and one liter are then removed during this relieving puncture. If there is no regression of the pleural effusion or if a bacterial infection leads to an accumulation of pus within the pleural gap, a permanent drainage can be applied.
A rubber tube is inserted into the area of the effusion using a needle as a guide rail, which then remains there for a few days. If necessary, a valve can be used to constantly drain off the excess fluid. If an infection is present, the pleura can be rinsed and treated with antibiotics.
The so-called pleurodesis can also be used in the case of an untreatable cause, such as malignant pleural mesothelioma.For this purpose, the inner and outer sheets of the pleura are glued together with the help of medication so that no more fluid can accumulate in between. Possible drugs are tetracycline or bleomycin, as well as the mineral talcum. If a pleural effusion is caused by a long-lasting bacterial infection, it may lead to severe suppuration or adhesions within the pleural gap.
In this case, the adhesions or the so-called pleural ridges that form can be removed surgically. This procedure is called decortication. Decortication allows the lung to fully unfold again.
The pleural effusion in pneumonia
If fluid collects in the space between the pleural leaves, the pleura and lung, this is called a pleural effusion. This can have numerous causes. In about one third of cases, it is pneumonia or pneumonia.
Triggers are usually bacteria or viruses. In pneumonia, an inflammatory reaction takes place that can spread to the pleura. At the beginning one speaks of pleuritis, i.e. an inflammatory involvement of the pleura.
As a result, a liquid, protein-rich effusion of inflammatory cells develops. Complaints in the form of pain occur mainly as a function of breathing. With increasing volume of the pleural effusion, the difficulty in breathing increases.
The pain decreases at the same time. Other typical symptoms of pneumonia are sudden coughing with purulent sputum, an increased respiratory and pulse rate and a significant rise in temperature. An ultrasound examination provides evidence of a peural effusion already from 50ml.
The CT is able to detect even the smallest volumes. The antibiotic therapy of pneumonia plays an important role in the therapy. In this way, the cause of the effusion is treated.
Furthermore, pleural puncture can be used to relieve the pressure in the acute situation. A so-called thoracic suction drainage, on the other hand, promotes small effusions over several days. It is used when the space between the pleural leaves is infected or an effusion persists.
