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Respiratory Disorders (Expert Forum)
Numerous Pneumonia's and Exudative Pleural Effusion of Unknown Cause
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Numerous Pneumonia's and Exudative Pleural Effusion of Unknown Cause
by krystalbelle, Jul 02, 2004 12:00AM
I am a 44 yr old female. Since December I have had numerous pneumonia's consistent with Acid Reflux. Had Nissan Fundoplication on May 13 for severe GERD then another bout of pneumonia. On June 11 hospitalized for left side exudative pleural effusion of unknown cause perhaps trauma of surgery. PE ruled out. CT Scan shows additional infiltrates in right lung which may be consistent with autoimmune disorder. Pleural fluid was indeterminate. I continue to have shortness of breath and chest discomfort with breathing. Drs say takes time for effusion to heal even months, next xray scheduled for July 19th still have decreased breath sounds in left lung. Not taking any medication as cause is unknown. I am very worried about this. My mom died of pulmonary fibrosis with pleural calcification, grandmother and great-grandmother of emphysema. What are recommended next steps? Some articles I have read say that it is important to find out cause of Pleural effusion as you must treat underlying condition. Some state that when fluid doesn't show anything important to get a biopsy. Is that true. My next scheduled appt with my pulmonologist is not until end of October. I am concerned that is too far out. Do I have reason to be concerned? How should I proceed? Should I get a second opinion?
Doctor's Answer
by National Jewish, Jul 12, 2004 12:00AM
, Jul 12, 2004 12:00AM
Generally a Nissan Fundoplication will stop aspiration caused by gastroesophageal reflux disease (GERD). A pH probe would be one of the simplest ways to sure that the GERD is under control. As long as your GERD is under control, it can no longer be assumed to be the cause of your numerous pneumonias, especially your most recent bout. This suggests that there is some other cause of your lung problems.
The lung is covered with a very thin membrane, called the pleura. A similar membrane covers the inside of the chest wall, the ribs and muscles. As the lungs expand and contract, these lubricated membranes glide over each other. There is normally no space between them. Following surgery it is possible for fluid to build up in between these two membranes. This can also be caused by infections such as pneumonia. There can be 1 to 2 liters of fluid in this area. The fluid can be watery, clear, cloudy, bloody or purulent, containing pus. This collection of fluid is called a pleural effusion. This fluid compresses the lung making it hard to breathe and causing shortness of breath.
You are correct in stating that one must treat the underlying cause of the pleural effusion. The physical, biochemical and microbiological characteristics of the fluid will most often provide clues as to the cause of the fluid. Other tests that can be helpful in finding the cause of the fluid are cultures, including cultures for tuberculosis (TB), checking for a variety of biochemical markers, and looking at the cells in the fluid. Usually this testing would have found the cause. Since it has not, you should have a biopsy. This is not an emergency. It’s fine to wait until after your next x-ray on July 19th. However if your next x-ray shows a lack of improvement in both the pleural fluid and the infiltrates, you should proceed with the biopsy. It is preferable that this biopsy be done by video assisted thoracoscopy (VATS), not by bronchoscopy. VATS is a surgical procedure that allows several different pieces of lung tissue to be taken for testing through two small incisions. A scope with a video camera at one end is placed through one of these incisions. A bronchoscopy is a procedure where a tube called a bronchoscope is passed through your nose into your windpipe to look into your lungs. With the bronchoscope tiny pieces of lung tissue can be taken for further testing.
The lung is covered with a very thin membrane, called the pleura. A similar membrane covers the inside of the chest wall, the ribs and muscles. As the lungs expand and contract, these lubricated membranes glide over each other. There is normally no space between them. Following surgery it is possible for fluid to build up in between these two membranes. This can also be caused by infections such as pneumonia. There can be 1 to 2 liters of fluid in this area. The fluid can be watery, clear, cloudy, bloody or purulent, containing pus. This collection of fluid is called a pleural effusion. This fluid compresses the lung making it hard to breathe and causing shortness of breath.
You are correct in stating that one must treat the underlying cause of the pleural effusion. The physical, biochemical and microbiological characteristics of the fluid will most often provide clues as to the cause of the fluid. Other tests that can be helpful in finding the cause of the fluid are cultures, including cultures for tuberculosis (TB), checking for a variety of biochemical markers, and looking at the cells in the fluid. Usually this testing would have found the cause. Since it has not, you should have a biopsy. This is not an emergency. It’s fine to wait until after your next x-ray on July 19th. However if your next x-ray shows a lack of improvement in both the pleural fluid and the infiltrates, you should proceed with the biopsy. It is preferable that this biopsy be done by video assisted thoracoscopy (VATS), not by bronchoscopy. VATS is a surgical procedure that allows several different pieces of lung tissue to be taken for testing through two small incisions. A scope with a video camera at one end is placed through one of these incisions. A bronchoscopy is a procedure where a tube called a bronchoscope is passed through your nose into your windpipe to look into your lungs. With the bronchoscope tiny pieces of lung tissue can be taken for further testing.
Member Comments (2)
by matt72582, Aug 04, 2004 12:00AM
I've had pleurisy for about 4 months constantly, but I'm sure there were occurrences before. I saw tons of doctors and hospitals. All they give me are anti inflammatory that have done nothing. I've been taking Vicodin (seems to make it worse), and now Ambien just to sleep because of the pain. I even took 2 tonight and noticed blood in my stool. My breathing sucks, but the worst pain is the pain on my sides, it kills, usually on my left side, but its constant, never goes away. I can't live like this. Can someone help me, or relate to what I'm going through?
