Pleural effusion and pleurodesis for lung cancer

The pleura cover the lung and normally there is no space between the inside (visceral) and outside (parietal) layers. A pleural effusion is an abnormal collection of fluid, which gathers in between the two layers. This may cause a fast heart rate and difficulty with breathing.

When a pleural effusion occurs the doctor may recommend a thoracentesis, the removal of a sample of the fluid to make a diagnosis. A man who was eventually diagnosed with mesothelioma had had this procedure, and a biopsy at the same time; the procedure had not been painful (see also ‘Lung cancer – investigations‘).

Describes his pleural effusion and how fluid and part of his lung lining was removed for analysis.

Age at interview 62

Gender Male

Age at diagnosis 61

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Now that was, by this time it was sort of end of February, last year, 2002. The X-rays came back the same day, and his immediate reaction was, ‘You shouldn’t be walking around like this’, because he realised that, well the X-ray showed; that the largest part of the left, the left part, left lung, was shrouded in fluid, and I was actually running on one lung. And that was why I was short of breath, all quite logical really.

Obviously the next thing was to find out why the fluid was there. I was.. he did, at the local hospital they did tests, and culminating in a biopsy test where he, injected to remove some of the fluid, which he sent away for, analysis, and at the same time use; a slightly bigger type of needle that has a sort of claw, where there could take a little bit of the lung lining. This was all done just on local anaesthetic. And they removed a little bit of the lung lining also for biopsy. These were sent away and in fact came back without any answers having been found, and he told me at that time that they were interested in looking at, TB, pleurisy and a few others that I don’t remember, but, but, various investigations.

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Removing the fluid from around the lung can help to relieve breathlessness. The fluid may be drained by drawing it off or by inserting a drainage tube. One man, also diagnosed with mesothelioma, described how fluid was aspirated. He said that the doctor removed one and a half litres of fluid, perhaps too much at once, which made his lung go into ‘trauma’ and which temporarily made it hard for him to breathe.

Describes the aspiration of his pleural effusion and a side effect of this procedure.

Age at interview 54

Gender Male

Age at diagnosis 53

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Yes they aspirated the effusion by, with a needle. I had to lean over the little table you have in hospital and they gave me a small shot of local anaesthetic and then they just put a long needle in through my, through the ribs, through the back and then they just draw it off and drain it into containers. And it really wasn’t, I didn’t feel it at all until they’d taken too much, so up until then it wasn’t a problem at all. It sounds frightening but it wasn’t. I didn’t look at the needle or anything like that to see how big it was. And my wife managed to watch it okay so it was okay.

They aspirated one and a half litres of fluid and then my lung went into trauma because they’d taken so much off in one go which meant I couldn’t breath properly. I could only, I could cough out but I couldn’t breathe in so that was, that was quite frightening and I had to have oxygen. And they stabilised me okay and x-rayed me to make sure my lung hadn’t collapsed but they did say that they’d taken off too much fluid in one go. And the fluid was quite a runny liquid but it had blood in it, they described it as being like Ribena. Again showing no signs of any infection.

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The fluid from around the lung often re-accumulates and the doctor may then perform a procedure called a ‘chemical pleurodesis’. Local anaesthetic thorascopy is now more widely used to achieve pleurodesis the procedure can be done as an outpatient.

The aim of the pleurodesis is to cause some inflammation between the two layers covering the lung. This inflammation makes the two layers stick together, and a sort of scar obliterates the space between the layers, so preventing further fluid from accumulating.

A variety of agents can be inserted into the pleural space to cause the inflammation, including talc. One man, who had mesothelioma, was first thought to have had a pulmonary embolism, so he was given warfarin, which made him prone to bleeding. He described his experience of a pleural effusion and the insertion of a chest drain. He then had a pleurodesis operation to prevent blood and other fluid accumulating in the pleural space.

Describes his pleural effusion and the insertion of a painful chest drain.

Age at interview 55

Gender Male

Age at diagnosis 54

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I went back to work, within ten days I just could not breathe at all so back to the doctor’s. He sent me straight back to the hospital again and there they x-rayed me and found that I had a chest full of fluid. I was given a chest drain, which is probably the most uncomfortable thing youll ever have.

Can you explain how they did that?

Well they just nick your skin here in your side and push a tube into your chest, into your chest cavity and

With local anaesthetic?

Yeah you’re still awake but it’s not painful so much as uncomfortable, but of course when the anaesthetic wears off and youve got it in there for three days, it does get very painful and very difficult to sleep.

That was draining fluid out?

Absolutely yeah and the fluid that was coming from my cavity was almost pure blood, it was bright red, very dark red.

What were your feelings at that stage, you mustve been a bit nervous?

No I was, because I was told that I had an embolism, I just thought well they said that you know it’s a rare thing to have and youll get over it.

So at that stage the doctors thought it was due to an embolism?

Yes and I was still on the warfarin tablets then and taking them regularly. But anyway I was in for three or four days and they drained my chest out, I felt great after that, came home. I didnt go back to work then, the doctor wouldn’t sign me off but after a week I was, I was just so impossible for me to breathe again, so back to the doctor’s again, back to hospital. There again I had another x-ray and another chest drain and again it was bright red, but even then I feel that theyd missed out on opportunity because I never, they still never suspected anything else other than this embolism.

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Explains why he had a pleurodesis operation and a biopsy.

Age at interview 55

Gender Male

Age at diagnosis 54

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Alright so youve had the biopsy and youve had the bronchoscopy, did they then decide they knew what the matter was?

No, no.

Not then?

No.

So what happened after that?

I was sent to another hospital, in our local hospital we just havent got the facilities to do those sort of tests, so I was sent to another hospital. There I was put to sleep under anaesthetic and two incisions were made into my back and there they could actually get access to the chest wall as well as the lung. They took scrapings from each side of that. But while I was having the operation they did find a tumour, that was quite a large hole, so they did an operation which is called a pleurodesis which actually sticks the lung over the tumour so the hole is sealed then with the lung so it’s actually all welded together. Which; the problem was that where Id been on the warfarin it had thinned the blood and stopped it clotting so the tumour was actually bleeding into my chest cavity, but when I stopped the warfarin it certainly slowed the bleeding down quite a lot, but I was still getting this problem of blood into the chest cavity. So by doing the pleurodesis and putting the lung over the hole it stops the fluid growing into, you know flowing into your chest cavity which is; Ive never had a chest drain since that operation which was in February.

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One woman, who had non-small cell lung cancer, had a problem two weeks after her operation. The lung had collapsed so she needed another chest drain, a procedure she found painful. She also had a talc pleurodesis, which was also done on the ward.

She describes her talc pleurodesis.

Age at interview 59

Gender Female

Age at diagnosis 56

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I had my operation on June 2nd, I went to theatre about half past eight, and I can’t remember anything at all. I can remember, I think at first time about half past seven at night, I can see his face, but that’s it, then. And then, next morning I felt a lot better. I hurt, but I felt a lot better. I’d got a tube in me and I were on this machine to get air out of me lung, and I were on that for three weeks. Only place I could go is round me bed.

Anyway, I think it were after a fortnight, I can remember one night the doctors came, and it were, me lung weren’t stopping up. As soon as I came off that machine, me lung were going down. So this doctor said, ‘I think this tubes moved, well have to put it in a different position. But they didn’t take me to theatre. They put this green cloth over me and did it while I were in that bed. And I’ve experienced pain, I’ve had children, but I have never experienced pain like that. And I said to ’em, I can remember distinctly saying to ’em, ‘If you do not give me something for this pain, I cannot accept responsibility for what I do. I said, ‘Because I’m going to pull every plug out that you’ve put in. I’ve never experienced pain like it, and it were over and done with in half an hour, you know, and they were lovely doctors. And it worked, because they put talcum powder into my lung and I was still stuck onto this machine that I haven’t a clue, the only thing I know is it, there were a little hole in me lung, and they couldn’t, so air were coming out or going in, whatever it, I haven’t a clue.

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