'Fluid Accumulation in the Chest Cage and Cardiac Membrane', which manifests itself with complaints such as cough, shortness of breath, chest pain, weakness, palpitation, should not be neglected in patients with lung cancer. Experts emphasize that patients with lung cancer should apply to a thoracic surgeon when these complaints begin. What you need to know about the subject, Thoracic Surgery Specialist Prof. Dr. Ozkan Demirhan told me.
Stating that 'Fluid Accumulation in the Chest Cage and Cardiac Membrane' is seen in patients with lung cancer, Prof. Dr. Özkan Demirhan said, “The membrane surrounding the lung and the inner surface of the ribs is called the pleura. The membrane above the lung is called the visceral pleura, and the membrane surrounding the chest wall is called the parietal pleura. The space between these membranes is called the pleural space. In some cases, fluid accumulation occurs in the pleural space. Lung cancer is the most common cause of cancer-related fluid accumulation. When there is fluid accumulation in the pleural space due to lung 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 the accumulation of fluid in the pleural space due to lung cancer, either the production of fluid is excessive or the drainage pathway in the membranes that allow the absorption of fluid in the pleura is blocked. It is impossible to detect it. Fluid accumulation in the pericardium is caused by radiotherapy for lung cancer, pericardial involvement of cancer, and sometimes reactionary fluid accumulation. said.
Pay attention to the symptoms!
Referring to the symptoms of 'Fluid Accumulation in the Chest Cage and Cardiac Membrane', Demirhan said, "There are complaints related to the amount of fluid in pleural fluid accumulation. When the amount of fluid is low, the patient may not have any complaints. There may be complaints such as cough, shortness of breath, chest pain (pain decreases as the amount of fluid increases), weakness. Pericardial fluid accumulation (malignant pericardial effusion) can lead to more serious and life-threatening symptoms than pleural fluid accumulation. It is usually associated with pleural effusion, but sometimes only pericardial effusion may be present. Patients with mild pericardial fluid may not have symptoms, but still have an increased heart rhythm, that is, they have palpitations. In advanced pericardial effusions, complaints such as shortness of breath, excessive increase in heart palpitations and low blood pressure are observed. Cardiac tamponade is a condition that prevents the heart from working. This is a life-threatening situation.” he said.
When the complaints start, they should definitely consult a thoracic surgeon.
Expresses that it is vital to see a specialist without wasting time when complaints begin. Dr. Özkan Demirhan said, “When the above-mentioned complaints start in patients with lung cancer, they should definitely consult a thoracic surgeon. First, the patient's history is taken. Information about the disease is obtained. His treatments are evaluated. On physical examination, lung sounds were decreased on the side with pleural fluid. There may be heart palpitations and low saturation. Then, radiological ultrasonography, chest X-ray and tomography are performed. Echocardiography is performed in addition to CT to detect pericardial effusion. Echocardiography shows the force of contraction of the heart and how much the heart is affected by the fluid. said.
Referring to the details of the treatment methods, Özkan Demirhan continued 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 may not cause serious complaints. An increase of 100 cc of fluid in the pericardium can lead to serious clinical symptoms.
Pericardial fluid should always be a priority in treatment. Since it is usually detected at the same time as pleural fluid accumulation, the treatment plan should be made together.
Minimal pleural fluid can be followed or a simple pleural catheter can be inserted. If the general condition of the patient with moderate and advanced pleural fluid is suitable, pleural drainage and pleurodesis (attachment of the lung membrane) should be performed with VATS, which is a minimally invasive intervention. During this procedure, I also use an indwelling pleural catheter to increase the success of the procedure. Permanent pleural catheter can be inserted in patients whose general condition is not suitable for VATS.
Pericardial drainage is performed during VATS applied for pleural effusion, which is the treatment option for pericardial fluid, and in the meantime, I prevent recurrence of pericardial effusion by opening a pericardial window.
If only pericardial effusion is present, pericardial drainage is performed under local and general anesthesia.
In patients with pleural and pericardial effusion, we also apply local chemotherapy drugs both for treatment and to prevent recurrence of fluid accumulation. With this process, we both prevent fluid accumulation and give chemotherapy drugs that affect cancer cells because These patients sometimes find it difficult to receive systemic chemotherapy.”
