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Avatar universal

No answer for the fluid yet

I'm 41 and never had any medical problems.  Since Jan 5 I've had pleurisy type pain in my right lower lung that was mis-diagonsed by a chest xray first at pneumonia, then a mass, then scar tissue.  After seeing a specialist, we've done every blood test, heart test, and lung test including a recent thoracentisis.  And there is no answer for the fluid in my right lung.  They drew out 100cc and my dr said there is about 400cc left.  Since Feb 24 I've now got severe pleurisy pain in my left lung also.  I haven't slept in over 7 weeks because I can't lie down.  My choices, I was told, was to wait a few months to see if it clears up, or go have a biopsy done, but it's possible I can still get no answers. I think One possibility is that it's asbestos related, doing my husbands laundry 18 yrs ago.  The computer says that 85% of fluid tests won't show the asbestos cancer.
Does pleurisy really last this long, and longer, or would you suggest anything further, like biopsy or ???? Any help would be greatly appreciated.
5 Responses
251132 tn?1198082422
This is not a situation for watchful waiting.  An aggressive approach is needed.  You should have a biopsy by thoracoscopy done by a specialist with great experience with the procedure.

Video-assisted thoracoscopic lung biopsy (VATS) is a less invasive surgical procedure.  It 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.  Recovery is generally fast and uneventful.

There are a lot of potential causes of your problem.  Many of them are treatable.  Chest x-ray, CT scan, blood tests or examination of the fluid may not find these problems.
Avatar universal
this is quit common senario in respirology. the fluid in the pleural space is called pleural effusion and it is divided in to 2 typres based on thoracocentesis result; exudative which is increase in pleura permeability secondary to various conditions like infectious, inflammatory, cancerous, the other typr is transudative which is secondary to change in driving pressures to accomulate fluid in the pleural space and this form is related to cardiac, liver, types of kidney diseases. the general approach and probability of etiology is guided by patient history, then thoracocentesis performed in attempt to categorize into transudate or exudate type. TB testings done always and if no answer yet then CT Chest done to look for abnormal lung tissue abnormalities, hidden cancers, asbestos related findings, rheumatoid arthritis lung findings, lupus lung findings, pulmonary embolism (clot), and pleural tissue abnormalities and many other causes like metastesis to the pleura. if still no answer then thoracoscopy done by thoracic surgeon with biopsy taken will give more detail about the histology. the blood work that is done is CBC, kidney function, liver function, RF (RHEUMATOID FACTOR), ANA (ANTINEUCLEOR ANTIBODY), anti-dsDNA (ANTI-DOUBLE STRANDED DNA)if ana is positive, lipase is pancreatitis was probable. radiological tests would include CT chest as i said, abdominal imaging would be required if abdominal malignancy is suspected especially ovaries in a female. the presence of pleurisy is indicating an ongoing inflammatory process and the yield of a biopsy will likely be positive.

this a detailed approach that i hope it will help you understanding the idea of your disease.
Avatar universal
I still don't understand why every test, CT Chest, VQ Scan, TB test, Cardiac test, blood work, EVERYTHING is coming back with NOTHING.  Would I really move forward and have a biopsy done?
I've heard that pleurisy can go away on its own.
Avatar universal
these tests are important when no direct answer available. as i mentioned the possibilities for the etiology for pleural effusion really wide. if these tests negative then biopsy is mandatory either by pulmonologist or thoracic surgeon via thoracoscopy.
Avatar universal
IT's been three months now and I'm not much better.  I now have fluid in my left lung also.  I went to NY City to specialists and they don't believe that it's anything serious.  Blood work shows up great, so it's not Lupus or ???  I was told to wait another 6 weeks, and if the fluid doesn't go away, then we can do a biopsy.  Does that sound right to you also?
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