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Suggest Treatment For Pleural Effusion Along With Tuberculosis
Question: Hi Doc, I am being treated for Pleural effusion + TB. This is my second month of ATT. The fluid has been drained out thru medical procedure. Now I am being told that some fluid has thickened and cann't be removed thru the procedure. I have been advised a regular key hole surgery for removal of the jelly from the pleural. But some chest experts also say that this can be cured by medication and no need for surgery. Could your advise the best course ?
Brief Answer:
Large multiloculated collection always requires keyhole surgical removal
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Pleural effusion is a common occurrence in the early stages of lung TB. At first the patient is put on ATT as you have been given and if the fluid is in large quantity then attempts are made to take out the fluid by needle aspiration or inserting chest tubes. I guess your doctors have tried draining as much fluids from your lungs by needle or chest tube insertion.
Sometimes the fluid between the pleural space thickens and forms membranes like septations and this is difficult to remove by needle or chest tubes. Doing a chest CT scan usually shows in detail about the septations and thickened fluid which is then called as a multiloculated collection. If this multiloculated collection is small then there are methods to treat it using medications and injections containing enzymes. If it is larger then a key hole surgical approach might be required to take out the collection which has thickened.
Most likely the collection in your case might be larger and not allowing the lungs to expand adequately and this is delaying your TB recovery. To confirm this it is important to have a look at your recent chest X ray and CT scan chest reports.
However, doing a key hole surgery is the easiest way to get the thickened collection out if the medications are not working. Techniques used are safe and there is not much risk involved. Patient can go home soon after the procedure in most cases.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Large multiloculated collection always requires keyhole surgical removal
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Pleural effusion is a common occurrence in the early stages of lung TB. At first the patient is put on ATT as you have been given and if the fluid is in large quantity then attempts are made to take out the fluid by needle aspiration or inserting chest tubes. I guess your doctors have tried draining as much fluids from your lungs by needle or chest tube insertion.
Sometimes the fluid between the pleural space thickens and forms membranes like septations and this is difficult to remove by needle or chest tubes. Doing a chest CT scan usually shows in detail about the septations and thickened fluid which is then called as a multiloculated collection. If this multiloculated collection is small then there are methods to treat it using medications and injections containing enzymes. If it is larger then a key hole surgical approach might be required to take out the collection which has thickened.
Most likely the collection in your case might be larger and not allowing the lungs to expand adequately and this is delaying your TB recovery. To confirm this it is important to have a look at your recent chest X ray and CT scan chest reports.
However, doing a key hole surgery is the easiest way to get the thickened collection out if the medications are not working. Techniques used are safe and there is not much risk involved. Patient can go home soon after the procedure in most cases.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thanks for your quick response.
Sorry i missed out on the recovery update. Post the fluid removal, the recovery is much quicker and now I am quite fine generally. Do you think I should wait for some more time before one takes a call for the surgery. Is there any harm in postponing by few weeks.
Sorry i missed out on the recovery update. Post the fluid removal, the recovery is much quicker and now I am quite fine generally. Do you think I should wait for some more time before one takes a call for the surgery. Is there any harm in postponing by few weeks.
Brief Answer:
If lung expansion adequate then you can wait
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Since you are feeling much better after fluid removal, it will help to know if your lung inflation is good. This can be known by doing lung function tests. My point is that the multiloculated collection, is sufficient enough to reduce your lung breathing volumes then you can go for the key hole surgery immediately. If the lung breathing volumes are in the normal range then you can wait and see if medications can still dissolve the multiloculated collections.
The treatment is targetted at your recovery and least complications involved. Please take ATT regularly and missing it even for a day can cause the recovery to get delayed.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
If lung expansion adequate then you can wait
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Since you are feeling much better after fluid removal, it will help to know if your lung inflation is good. This can be known by doing lung function tests. My point is that the multiloculated collection, is sufficient enough to reduce your lung breathing volumes then you can go for the key hole surgery immediately. If the lung breathing volumes are in the normal range then you can wait and see if medications can still dissolve the multiloculated collections.
The treatment is targetted at your recovery and least complications involved. Please take ATT regularly and missing it even for a day can cause the recovery to get delayed.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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