I will be going in for a thoracoscopy next week to determine the cause of a recurrent pleural effusion. The first effusion happened in Dec. 2012 with no known etiology (negative cytology) and fully resolved on its own by March. I also had a CT scan in May with nothing of consequence on the scan. The last chest xray was taken in Sept. of this year with no fluid but did indicate adhesions (which was the purpose of the CXR).
The new effusion came on in early October and again was negative in cytology following thoracentesis. The effusion has since reaccumulated in three weeks and appears (and feels) to be loculated. I did have a couple of weeks of low grade fevers and night sweats that have since subsided. During the discussion with the surgeon who will be performing the thoracoscopy, he mentioned doing pleurodesis.
My question is that I am an active 39 year old male and wonder what long term issues pleurodesis present. Should this effusion be infectious in nature - which is what the surgeon felt may be the case, are there drawbacks to this that may affect my lung capacity or contribute unnecessary pain? Also, would it be typical for a effusion that is malignant in nature to fully resolve on its' own without treatment only to recur 10 months later (which included a CT scan that appeared entirely unremarkable only months prior)?
Reply # - November 17, 2013, 09:35 AM
Reply To: Pleural effusion
kmkron, Our faculty aren't the best doctors to ask most of these questions. Our oncologists work with people with a cancer diagnosis therefore are willing to take much larger chances for short and long term complications to rid themselves of lung cancer. Those who aren't curable work to balance longevity and quality so these goals also create unique treatment plans.
Mostly cancer related complications don't go away without treatment.
One of our dear members whose now gone would probably suggest that you ask your doctors to do a complete workup on the fluid for unique infections including bacterial. Unfortunately a cancer dx may not be caught in the fluid though odds do get better with repeated checks.
We have a section on PE both in our blog posts and forums. The last 2 on this list are prob best. http://cancergrace.org/lung/category/lung-cancer/general-lung-cancer-is…
forums: http://cancergrace.org/forum/lung-thoracic-cancer/lung-cancer-complicat…
With that said I'll ask our pulmonary specialist to comment. Note he works primarily in a cancer center.
All best,
Janine
Reply # - November 17, 2013, 01:05 PM
Reply To: Pleural effusion
Kmkron, in your post you didn't mention any test or biopsies for Lung Cancer and since you don't have a signature made out I was just curious! I understand you don't have to have Cancer to get the pleural Effusion, so I hope you are Cancer Free! Lorrie!
Reply # - November 17, 2013, 01:56 PM
Reply To: Pleural effusion
Not currently diagnosed and hope it stays that way following next week's thoracoscopy. Biopsies will be taken as the Pulmonologist has shown concern with last effusion that was bloody, but had negative cytology. Have had other symptoms that may be consistent with an infection, but nothing found in fluid.
I'm mostly concerned about the pleurodesis and the potential that it may cause long term issues/pain. I've heard many issues regarding this procedure. I realize most everyone here is directly affected by cancer, and not being diagnosed myself, I hope that my questions don't offend. I'm only asking as pleural effusions are a very common issue related by many in this forum and hoping someone may have some valued input.
Reply # - November 17, 2013, 07:40 PM
Reply To: Pleural effusion
I'll vouch that you'll get valuable input before too long. You're right about others on Grace being directly affected by cancer so for me that's the only reference I have. Procedures can be the same but perspective changes. Pleurodesis is one option some people have a pleurex catheter put in. I believe I understand the cath is a newer option. It may not have as long lasting effects. Some of that info is in the posts.
All best,
Janine
Reply # - November 17, 2013, 07:46 PM
Reply To: Pleural effusion
I appreciate your concern about offending, but I don't think that's a significant concern. Our limitation is more that a malignant pleural effusion leads to a staging of advanced lung cancer, which doesn't typically improve for 10 months and then return again from nowhere. The real issue is that we can't really address long-term side effects of pleurodesis because it's just not a relevant question for those with a malignant pleural effusion, who are typically far more focused on shorter-term battles. But I've know quite a few people who have undergone a pleurodesis years earlier or had an infection or cancer essentially cause the same process naturally, then do well for a very long time, and it's not typical to have long-term side effects in that setting.
Good luck.
-Dr. West
Reply # - November 18, 2013, 07:42 PM
Reply To: Pleural effusion
Dr. Silvestri commented via email and is pasted below. Hope this helps.
"It is difficult to answer your question about the thoracoscopy and subsequent side effects without knowing the nature of the effusion. Generally, it is a diagnosis that for the purposes of your case will fall into 2 buckets, cancer or no cancer. If it is not cancer, then I do not recommend pleurodesis as it should resolve with drainage and managing the underlying condition (antibiotics for infection, etc) or may even just the act of relieving the loculations. If it is cancer pleurodesis is appropriate and the side effects are usually minimal. Some surgeons like to do pleurodesis either way so that fluid does not re accumulate. There is not to much of a downside to that. The main goals of this procedure should be to get all the fluid out and make a diagnosis. By the way, the clinical description you give is less likely to be lung cancer and more likely infection. Best of luck."
Gerard A. Silvestri, MD, MS
Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Medical University of South Carolina
Reply # - November 19, 2013, 09:24 AM
Reply To: Pleural effusion
I would like to thank those that provided feedback on my questions. It is nice to have a resource such as this, especially for those who are experiencing difficult decisions and looking for improved quality of life. I won't have a better understanding of my status until later next week following the VATS procedure, but regardless of the outcome, I am encouraged to know that this resource exists. Thanks again!
Reply # - November 30, 2013, 07:43 AM
Reply To: Pleural effusion
I wanted to follow up on my initial post. I had the VATS procedure this past Monday and all biopsy samples came up negative. I ended up having a grade III empyema that required decorticating of the lung. The surgeon elected to forgo the pleurodesis based on the fact that the decorticating would accomplish similar results. While the underlying cause has not (and probably will never be) identified, I'm quite relieved there is no signs of malignancy. I'm still recovering in the hospital on Saturday, but expect to make a full recovery.
I appreciate the kindness and generosity shown in this forum. I also hope everyone utilizing this wonderful resource now and in the future finds the help and peace they are looking for. Best wishes to all!
Reply # - November 30, 2013, 10:02 AM
Reply To: Pleural effusion
That's great kmkron! So good to know you have no malignancy. You're very kind to let us know how the biopsies turned out and you won't be needing us anymore. Thanks for the kind words and wishes.
All best wishes to you as well,
Janine
Reply # - November 30, 2013, 12:48 PM
Reply To: Pleural effusion
KmKRon, great News! I'm so very Happy you are Cancer Free! Good Luck to you on getting rid of the PE! Lorrie
Reply # - November 30, 2013, 02:39 PM
Reply To: Pleural effusion
That's still a pretty scary diagnosis and hope they find the cause of it soon. Are you in the US? Wishing you the best in recovery. Take care, Judy
Reply # - November 30, 2013, 06:08 PM
Reply To: Pleural effusion
Yes, I wouldn't normally congratulate someone for having an empyema, but it's likely to be preferred over an advanced cancer. Thanks so much for letting us know.
-Dr. West