Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Pleural Effusion?
Question: My dad is 72. He had the earliest stage 1 lung cancer 2 years ago "cured" by lobectomy. He has checked out fine until now. In April he got a very bad respiratory virus so he got an xray that was fine, and he seemed to eventually get over the illness. In May he got a Ct scan due to severe fatigue that showed no fluid. When he went for his regular check up in July he was experiencing some shortness of breath and the Ct scan showed some fluid. They gave him a Z pack and said to come back in a month. Today we went back and the Ct with contrast showed more fluid than last month. The doctor said the fact that there was no fluid in May, but it developed so quickly in July and August that it would indicate to him an infection and it needs to be drained. He said he would do a biopsy also, and if necessary he would remove some skin that may have hardened making it hard for the lung to adequately expand. He said the hospital stay would be one or two days. My questions are these:
1. Even though the doctor said he suspects infection obviously we are worried about cancer. What are the odds that it is cancer instead? Can the doctor have a good idea that it is infection from the the Ct with contrast. He seemed fairly confident.
2. Could this be associated with the respiratory infection he had last April?
3. Are people who have had lobectomies more likely to get such infections?
4. What is the recovery time for this surgery if all goes well?
5. The doctor never mentioned that the cancer may have returned but he
did say "We need to make sure we are not missing something". Was that
his way of saying it may be cancer? He just mentioned inflammation that appeared
to be infection.
I am trying not to panic about this situation. A persons mind naturally goes to the worst case scenario that the cancer has returned. My dad has been physically
active and in good health until just a couple weeks ago. Any advice on this
would be appreciated.
1. Even though the doctor said he suspects infection obviously we are worried about cancer. What are the odds that it is cancer instead? Can the doctor have a good idea that it is infection from the the Ct with contrast. He seemed fairly confident.
2. Could this be associated with the respiratory infection he had last April?
3. Are people who have had lobectomies more likely to get such infections?
4. What is the recovery time for this surgery if all goes well?
5. The doctor never mentioned that the cancer may have returned but he
did say "We need to make sure we are not missing something". Was that
his way of saying it may be cancer? He just mentioned inflammation that appeared
to be infection.
I am trying not to panic about this situation. A persons mind naturally goes to the worst case scenario that the cancer has returned. My dad has been physically
active and in good health until just a couple weeks ago. Any advice on this
would be appreciated.
Brief Answer:
Possibility of infection and cancer, both are there.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your father's situation and problem.
Answer to your 1st question.
Most common cause for pleural effusion is infection.
But in diagnosed lung cancer patient, malignant pleural effusion is also a possibility. And one can not say confidently about etiology just on the basis of CT picture. Pleural fluid reports, biopsy and cytology are needed for confirmation.
Answer to your 2nd question.
I don't think it is associated with previous respiratory infection.
Answer to your 3rd question.
Pleural infection and metastatic spread are common after lobectomy in cancer patients. Please let me know if he has same side pleural effusion or not.
Answer to your 4th question.
If it is infection than recovery time is almost 1 month. But if it is malignant effusion than recovery time is much more.
Answer to your 5th question.
No, possibility of malignant pleural effusion is still there. But no need to worry because diagnostic tests are same for both, infection and malignancy.
So get done pleural fluid aspiration and it's reports. Also get done pleural biopsy.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your father.
Thanks.
Possibility of infection and cancer, both are there.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your father's situation and problem.
Answer to your 1st question.
Most common cause for pleural effusion is infection.
But in diagnosed lung cancer patient, malignant pleural effusion is also a possibility. And one can not say confidently about etiology just on the basis of CT picture. Pleural fluid reports, biopsy and cytology are needed for confirmation.
Answer to your 2nd question.
I don't think it is associated with previous respiratory infection.
Answer to your 3rd question.
Pleural infection and metastatic spread are common after lobectomy in cancer patients. Please let me know if he has same side pleural effusion or not.
Answer to your 4th question.
If it is infection than recovery time is almost 1 month. But if it is malignant effusion than recovery time is much more.
Answer to your 5th question.
No, possibility of malignant pleural effusion is still there. But no need to worry because diagnostic tests are same for both, infection and malignancy.
So get done pleural fluid aspiration and it's reports. Also get done pleural biopsy.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your father.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
If fluid comes back positive for cancer what does
that mean in terms of severity. Does that mean it
is a later stage with a bad prognosis. What do they
do for treatment? The doctor was so sure that the
cancer would not come back after the lobectomy.
that mean in terms of severity. Does that mean it
is a later stage with a bad prognosis. What do they
do for treatment? The doctor was so sure that the
cancer would not come back after the lobectomy.
Brief Answer:
Malignant pleural effusion needs pleurodesis.
Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
If pleural effusion is positive for malignant cells than he is having stage 4 lung cancer.
Malignant pleural effusion is considered as distal metastasis, so it is stage 4 disease.
Treatment is drainage of pleural effusion by intercostal drainage and pleurodesis.
Pleurodesis is adhesion of pleural layers by talc.
Chances of malignant pleural effusion are rare in lobectomy patients but better to rule out malignancy first.
Chances of infection are more but better to rule out malignant pleural effusion.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
I will be happy to help you further.
Wishing good health to your father. Thanks.
Malignant pleural effusion needs pleurodesis.
Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
If pleural effusion is positive for malignant cells than he is having stage 4 lung cancer.
Malignant pleural effusion is considered as distal metastasis, so it is stage 4 disease.
Treatment is drainage of pleural effusion by intercostal drainage and pleurodesis.
Pleurodesis is adhesion of pleural layers by talc.
Chances of malignant pleural effusion are rare in lobectomy patients but better to rule out malignancy first.
Chances of infection are more but better to rule out malignant pleural effusion.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
I will be happy to help you further.
Wishing good health to your father. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
