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Monday, December 9, 2013
Fluid in lungs
My chest x-ray showed fluid in the lungs. I have used Tuberculosis treatment in year 2001, repeated doses in 2004 but in vain. What treatment should I use? No TB VIRUS FOUND. Is it TB as they suggested?
"Fluid in the lungs" can refer to congestion in the lungs themselves from many causes or to "pleural effusion" which is actually fluid build up in the space between the lungs and the chest wall. In both cases you can have shortness of breath and sometimes you may develop a dry cough or chest pain. Many cases of "fluid in the lung" have nothing to do with tuberculosis. Only your physician can sort through this.
I am not sure what type of tuberculosis you had or how your diagnosis of tuberculosis was made in the past. For discussion purposes, I am going to assume that you had a pleural effusion in 2001 and 2004, and after a thorough work-up no tuberculosis was found. However, because of your tuberculosis risk factors, physicians assumed that it was tuberculosis, and you were treated with multiple anti-tuberculosis medications for at least 6 months. Despite completing treatment for tuberculosis, the pleural effusion is still present.
Tuberculosis can cause pleural effusion but so can other infections such as viral pneumonia, bacterial pneumonia, fungal or parasitic diseases. Besides infections, lung cancer, pulmonary embolism (blood clot in the lung), rheumatic fever, systemic lupus erythematosous, other connective tissue disorders, certain drugs, heart failure, liver or kidney diseases can also cause pleural effusions.
If you were treated for tuberculosis and the effusion returned, the assumption would be that it may not have been tuberculosis or that if it was tuberculosis, the antituberculosis medication you were treated with may not have been the right ones (e.g. you have a drug resistant type of tuberculosis).
Because it is so important to try and find out the cause of the pleural effusion so that proper treatment can be started, I will try and go over the work-up of pleural effusion. Your doctor may have already done these additional tests or studies. Some additional radiology studies that might be helpful are an ultrasound which uses sound waves to create a picture of the inside of the body to confirm that there is an abnormal pocket of fluid, and a computed tomography (CT or CAT) scan (an imaging test that creates a three dimensional picture of the inside of your body with x-ray). The CT scan can also give you a good image of the effusion and other abnormalities in your lungs such as pneumonia, pulmonary tuberculosis, pulmonary embolism, or cancerous nodule.
The most important study is to remove some of the fluid and send it to the laboratory to be tested. This is usually done with a needle inserted into the pleural cavity, a procedure called a thoracentesis. In underdeveloped countries where tuberculosis is common, tuberculosis is a common cause of pleural effusion. Because it is often difficult to confirm tuberculosis from the fluid, patients with pleural effusion are often treated empirically for tuberculosis and their pleural effusion will improve and disappear with the tuberculosis treatment.
Because you have already been treated for tuberculosis and the effusion is still present, it is even more important to try and make a diagnosis.
If the fluid is not helpful in making the initial diagnosis, sometimes larger amounts of fluid might be needed. If you have a large pleural effusion, this can be done easily. Otherwise, a biopsy of tissue is needed. This can be done by a lung doctor or a surgeon. The surgeon can use a video-assisted devise to put a camera in the pleural space to take a look at the inside of the chest wall and the lung and get a piece of tissue to help with the diagnosis.
There are also several new PCR DNA tests that can be done on the fluid or the tissue biopsy to help with diagnosis of tuberculosis or other infections.
The bottom line for this question is to consult your physician to make sure that the "fluid in the lung" IS or IS NOT related to tuberculosis.
Shu-Hua Wang, MD, MPH&TM
Clinical Assistant Professor of Infectious Diseases
Clinical Assistant Professor of The Division of Epidemiology
College of Medicine
The Ohio State University
Larry S Schlesinger, MD
Molecular Virology, Immunology and Medical Genetics
Environmental Health Sciences
College of Medicine
The Ohio State University