Related Terms: Pleural effusion, pleural cavity, pulmonary edema
Another complication with lymphedema may be the build up of fluids in the cardio and or pleural cavities. There are numerous individuals on list that have experienced this complication. I had a mild one for years and suddenly this year it became extensive.
Pleural effusions appear to be more of an possibility with long term lymphedema. Conditions that would lead to it would be abdominal edema, any type of lymphatic cancer that impairs an already disfunctional lymphatic system, recurrent infections that have further damaged lymphatics, pulmonary lymphangiectasia.
If you have extensive lymphedema and experience difficulty in breathing, if your breathing is labored or you experience that “rattling” sound a simple x-ray should be sufficient to pick up and edema.
Since I shared publicly about my own struggle with lung fluid, with increasing frequency, lymphedema patients have written to me or posted comments about breathing problems, fluid on the lungs, or shortness of breath.
I have become convinced that pleural effusions (lung fluid, lung edema) associated with lymphedema is a seriously undiagnosed, under reported and significant untreated complication of this condition. It is therefore imperative that the awareness level be raised and that treating physicians and therapists become aware of the possibility that this could well effect their patient.
One condition is what is generally referred to as Yellow Nail Syndrome, and this is fairly well known and documented. Another condition, much less known of, but even more serious is pulmonary lymphangiectasia. In this condition, the lymphatics of the lugns are dilated and thus become unable to transport fluid. Until very recently an infant born with this condition faced an almost certain fatal prognosis.
However, there is mounting evidence that pleural effusion often accompany what we refer to simply as lymphedema. This includes both primary lymphedema and secondary lymphedema.
In my personal situation, starting in early 2005, I began to experience increasing lung fluid and serious breathing difficulty. This continued to get worse until now, I have had to have my lungs drained every month. Each time about two to two and a half quarts of fluid has been removed each time. Last Fall I had an all over lymphscintigraphy that demonstrated almost no lymphatic movement through the thoracic duct. It also became apparent that I could not continnue to go through monthly thoracocentesis to remove that fluid. In this procedure, a tube is inserted between the ribs and placed into the pleural cavity, removing the fluid. The bad thing about this procedure is you run the risk of pneumothorax (lung collapse) each time you enter the lung caivty, and I have had a number of these.
In January 2007, I underwent a pleuerodesis in the right lung. In pleurodesis, an irritant (such as Bleomycin, Tetracyclines, or talc powder) is instilled inside the space between the pleura (the two layers of tissue lining the lungs) in order to create inflammation which tacks the two pleura together. This procedure thereby obliterates the space between the pleura and prevents the reaccumulation of fluid. It is was only partially successful. While fluid accumulation in the right lung slowed, it conitnued unabated in the left lung.
This past week on April 11th, (2007) I had a Pleurx catheter system put into both lungs. Tubes were inserted into each lung cavity, running through the cavity and coming out my sides. I now will be able to drain my lungs weekly, in hopes of controlling the fluid accumulation. I eventually had one going into the abdomen as well. For several years, I drained 1000ML of fluid (ascites) from each tube every three days.
I hope this revised information will be of value and help. If you have lymphedema and begin to have difficulty in breathing, it is important you let your physician know and that the proper tests be conducted to achieve an accurate diagnoses. A simply xray will pick up whether or not you have fluid. Other radiological tests can verify and evaluate the extent of the effusion.
BTW, the great news for me has been that for several months now (2011), my lungs have remained clear and I have not had to drain them. Unfortunately, the damage has been done to the lung tissue so I am still on oxygen, a host of breathing meds and will probably have to remain on them as lung tissue doesn't heal.
Dec. 25, 2011
The pleural cavity is a closed space (like the inside of a balloon) within which the lung has grown. As the lung grows into the space, it picks up a layer of pleura (outside of balloon) and this is called the visceral pleura. The remainder of the pleura is called the parietal pleura. Pleura is a membrane that is single celled. Normally it produces a small amount of fluid that fills the gap between the parietal and visceral layers of pleura. The best way to see the various aspects of the pleura is to examine a cross section of the thorax and a frontal (coronal) section.
The pleura is a thin membrane that lines the inside of the chest wall and covers the lungs. There is normally a tiny amount of fluid between the two layers of pleura. This acts like lubricating oil between the lungs and the chest wall as they move when you breathe. A pleural effusion develops when this fluid builds up and separates the lung from the chest wall.
Transudative pleural effusions are caused by fluid leaking into the pleural space. This is caused by increased pressure in, or low protein content in, the blood vessels. Congestive heart failure is the most common cause.
Exudative effusions are caused by blocked blood vessels, inflammation, lung injury, and drug reactions.
Fluid Outside the Lungs
Pleural effusion is when fluid accumulates around the lung, in the pleural space. Blood (hemothorax), fatty lymphatic fluid (chylothorax) or pus (empyema) may also fill the pleural space although this occurs less frequently. Any fluid accumulation around the lungs should be taken seriously and requires immediate medical attention. The fluid accumulation around the lungs compress the lung and this prevents normal respiration, which results in inadequate gas exchange. The types and causes of pleural effusions are discussed in detail under fluid around the lungs.
Some Causes of Fluid Around the Lungs (1)
Congestive cardiac failure is one of the most common causes of a pleural effusion. This fluid is more thicker (transudative) due to protein that is ‘forced’ out of the blood vessels and into the pleural space.
An exudative effusion is a watery fluid accumulation due to inflammation, caused by lung cancer like pleural mesothelioma, infections like TB or pneumonia, lung disease like asbestosis or drug reactions.
A hemothorax may be a result of a trauma or rupture of large blood vessels in the case of an aortic aneurysm although the latter causing a pleural effusion is uncommon.
An empyema is the accumulation of pus within the pleural space often due to a lung abscess.
A chylothorax is the accumulation of lymphatic fluid, which has a high concentration of fat, and may occur in certain cancers like lymphoma.
Some of the causes of fluid accumulation inside the lungs may also cause a pleural effusion, including kidney failure and liver disease.
Other causes can include: Pulmonary embolism,
- rheumatoid arthritis, - abdominal disease (like Pancreatis) - liver diseases (like cirrhosis, Nephrotic Syndrome, Hepatic Hydrothorax)
A low level of protein in the blood also tends to allow fluid to seep out of the blood vessels. For example, cirrhosis of the liver and some kidney diseases may cause a low level of blood protein which allows a pleural effusion to develop.
Read more: Wiki
Chest pain, usually a sharp pain that is worse with cough or deep breaths
Shortness of breath
Although, some times there are no symptoms.
During a physical examination, the doctor will listen to the sound of your breathing with a stethoscope and may tap on your chest to listen for dullness.
The following tests may help to confirm a diagnosis:
Chest CT scan
Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, amount of protein, and presence of cancer cells)
Thoracentesis (a sample of fluid is removed with a needle inserted between the ribs)
Ultrasound of the chest
A lung that is surrounded by excess fluid for a long time may be damaged.
Pleural fluid that becomes infected may turn into an abscess, called an empyema, which will need to be drained with a chest tube.
Pneumothorax (air in the chest cavity) can be a complication of the thoracentesis procedure.
Other possible complications include:
If pulmonary edema continues, it can raise pressure in the pulmonary artery and eventually the right ventricle begins to fail. The right ventricle has a much thinner wall of muscle than does the left side because it is under less pressure to pump blood into the lungs. The increased pressure backs up into the right atrium and then into various parts of your body, where it can cause:
Leg swelling (edema) Abdominal swelling (ascites) Buildup of fluid in the membranes that surround your lungs (pleural effusion) Congestion and swelling of the liver When not treated, acute pulmonary edema can be fatal. In some instances it may be fatal even if you receive treatment.
Treatment aims to:(2)
Remove the fluid Prevent fluid from building up again Treating the cause of the fluid buildup
Therapeutic thoracentesis may be done if the fluid collection is large and causing chest pressure, shortness of breath, or other breathing problems, such as low oxygen levels. Removing the fluid allows the lung to expand, making breathing easier. Treating the cause of the effusion then becomes the goal.
For example, pleural effusions caused by congestive heart failure are treated with diuretics (water pills) and other medications that treat heart failure. Pleural effusions caused by infection are treated with appropriate antibiotics. In people with cancer or infections, the effusion is often treated by using a chest tube for several days to drain the fluid.
Sometimes, small tubes can be left in the pleural cavity for a long time to drain the fluid. In some cases, the following may be done:
Chemotherapy Putting medication into the chest that prevents fluid from building up again after it is drained Radiation therapy Surgery (2)
Preload reducers. Preload reducing medications decrease the pressure caused by fluid going into your heart and lungs. Doctors commonly use nitroglycerin and diuretics, such as furosemide (Lasix), to treat pulmonary edema. Diuretics may make you urinate so much initially that you may temporarily need a urinary catheter while you're in the hospital.
Morphine (Astramorph). This narcotic may be used to relieve shortness of breath and anxiety. But some doctors believe that the risks of morphine may outweigh the benefits and are more apt to use other, more effective drugs.
Afterload reducers. These drugs dilate your blood vessels and take a pressure load off your heart's left ventricle. Some examples of afterload reducer medications include nitroprusside (Nitropress), enalapril (Vasotec) and captopril (Capoten).
Blood pressure medications. If you have high blood pressure when you develop pulmonary edema, you'll be given medications to control it. On the other hand, if your blood pressure is too low, you're likely to be given drugs to raise it. (3)
The expected outcome depends upon the underlying disease and to the extent of the damage to the lung tissues themselves.
Serous fluid (hydrothorax)
Pus (pyothorax or empyema)
ICD-9 Unspecified pleural effusion 511.9
ICD-9 Pulmonary Congestions and hypostasis 514
ICD-9 Acute edema of lung, unspecified 518.4
UCD-10 Chronic pulmonary edema 381.1