Thoracic Surgery Specialist Prof. explains what you need to know about the subject. Dr. Özkan Demirhan explained: “The membrane surrounding the lung is called pleura. The membrane over the lung is called visceral pleura, and the membrane surrounding the chest wall is called parietal pleura. The space between these membranes is called the pleural space. In some cases, fluid accumulation occurs in the pleural space. The most common cause of cancer-related fluid accumulation is lung cancer, followed by breast cancer. When there is fluid accumulation in the pleural space due to breast cancer, there is also fluid accumulation in the pericardium, which is called pericardial effusion. Normally, there is minimal pleural fluid in the pleural space, and this fluid is produced and absorbed in a certain balance. In fluid accumulation in the pleural space due to breast cancer, either excessive fluid production or the drainage pathway in the membranes that absorb fluid in the pleura is blocked. It is not possible to detect it. "Fluid accumulation in the pericardium is caused by radiotherapy seen in breast cancer, pericardial involvement of cancer, and sometimes reactionary fluid accumulation." Said.
Watch out for the symptoms!
Referring to the complaints caused by fluid accumulation in the pleura and pericardium, Prof. Dr. Özkan Demirhan: “In pleural fluid accumulation, there are complaints depending on the amount of fluid. The patient may not have any complaints when the amount of fluid is low. There may be complaints such as cough, shortness of breath, chest pain (pain decreases as the amount of fluid increases), and fatigue. Pericardial fluid accumulation (malignant pericardial effusion) can lead to more serious and life-threatening symptoms than pleural fluid accumulation. It is usually accompanied by pleural effusion, but sometimes only pericardial effusion may occur. Patients with mild pericardial fluid may not cause symptoms, but their heart rhythm is still increased, meaning they may complain of palpitations. In advanced pericardial effusions, there are complaints such as shortness of breath, excessive heart palpitations, and low blood pressure. In addition, there is a condition that prevents the heart from working, which we call cardiac tamponade. “This is a life-threatening situation.” He spoke as follows.
How is the diagnosis made in these patients?
Referring to the diagnostic methods of fluid accumulation in the pleura and pericardium, Demirhan said, “When breast cancer patients experience the complaints mentioned above, they should definitely consult a thoracic surgeon. First, patients' histories are taken. Information about his illness is obtained. The treatments he received are evaluated. On physical examination, lung sounds were decreased on the side with pleural fluid. Heart palpitations and low saturation may occur. Then, radiological ultrasonography, direct chest radiography and tomography are performed. Echocardiography is performed in addition to CT to detect pericardial effusion. "Echocardiography shows the strength of heart contraction and how much the heart is affected by fluid." He gave information as follows.
How is the treatment done?
Touching on the details of the treatment process, Dr. Özkan Demirhan continued his words as follows.
“Treatment depends on the amount of pleural fluid and pericardial fluid detected. The effect of the amount of fluid in the pleural space and the amount of pericardial fluid is very different. There may be liters of fluid in the pleura and it may not cause serious complaints. An increase of 100 cc of fluid in the pericardium can lead to serious clinical symptoms. Fluid in the pericardium should always be a priority in treatment. Since it is usually detected simultaneously with pleural fluid accumulation, the treatment plan should be made together. Minimal pleural fluid can be monitored or a simple pleural catheter can be inserted. If the general condition of the patient with moderate to severe pleural fluid is appropriate, pleural drainage and pleurodesis (pulmonary membrane gluing) should be performed with VATS, which is a minimally invasive procedure. During this procedure, a permanent pleural catheter can also be applied to increase the success of the procedure. A permanent pleural catheter can be inserted into patients whose general condition is not suitable for VATS.
The treatment option for pericardial fluid is pericardial drainage during VATS for pleural effusion, and in the meantime, we prevent the recurrence of pericardial effusion by opening a pericardial window.
If only pericardial effusion is present, pericardial drainage is performed under local and general anesthesia.
We apply local chemotherapy drugs to patients with pleural and pericardial effusion both for treatment and to prevent recurrence of fluid accumulation. “With this procedure, we both prevent fluid accumulation and administer chemotherapeutic drugs that act on cancer cells, because these patients sometimes have difficulty receiving systemic chemotherapy.”
