Fluid in lungs needs clear diagnosis

[Guest guest]

NetWellness: Fluid in lungs needs clear diagnosis

Cincinnati Post - OH*

Ask the expert

Dr. Shu-Hua Wang

http://news.cincypost.com/apps/pbcs.dll/article?

AID=/20071204/LIFE/712040361/1005

Q: My chest X-ray showed fluid in the lungs. In 2001, I underwent

tuberculosis treatment. It was repeated in 2004, but in vain. What

treatment should I use? There was no TB virus found. Is it TB as

they suggested?

A: " 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 the diagnosis of

tuberculosis or other infections.

NetWellness, a collaboration of University of Cincinnati, Ohio State

and Case Western Reserve, is a consumer health information Web site:

www.netwellness.org. Today's answer is from Dr. Shu-Hua Wang,

medical director of the Ben lin TB Program and assistant

professor, Division of Infectious Diseases, OSU,, and Dr. Larry

Schlesinger, chief of infectious diseases and director of the Center

for Microbial Interface Biology, OSU..

[Guest guest]

thanks, for those of us dealing with this, I've read that it also can

envolve the heart and possible increase of stroke risk. I've noticed

that it seems the worse this is the more heart

palpatationss,fluttering effects. maybe they should include ekg

testing along with this.

--- In , " tigerpaw2c " <tigerpaw2c@...>

wrote:

>

> NetWellness: Fluid in lungs needs clear diagnosis

> Cincinnati Post - OH*

> Ask the expert

> Dr. Shu-Hua Wang

>

> http://news.cincypost.com/apps/pbcs.dll/article?

> AID=/20071204/LIFE/712040361/1005

>

> Q: My chest X-ray showed fluid in the lungs. In 2001, I underwent

> tuberculosis treatment. It was repeated in 2004, but in vain. What

> treatment should I use? There was no TB virus found. Is it TB as

> they suggested?

>

> A: " 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 the diagnosis of

> tuberculosis or other infections.

>

> NetWellness, a collaboration of University of Cincinnati, Ohio

State

> and Case Western Reserve, is a consumer health information Web

site:

> www.netwellness.org. Today's answer is from Dr. Shu-Hua Wang,

> medical director of the Ben lin TB Program and assistant

> professor, Division of Infectious Diseases, OSU,, and Dr. Larry

> Schlesinger, chief of infectious diseases and director of the

Center

> for Microbial Interface Biology, OSU..

>

[Guest guest]

>

> thanks, for those of us dealing with this, I've read that it also

can

> envolve the heart and possible increase of stroke risk. I've noticed

> that it seems the worse this is the more heart

> palpatationss,fluttering effects. maybe they should include ekg

> testing along with this.

===================================================

I develop fluid in my lungs if I take any sulfur related supplements

such as CoQ10 or NAC, folic acid etc. on consecutive days. I also get

fluid if I fail to wear a particulate mask outdoors now in most

locales. My doc called it pneumonitis, a pneumonia in which no virus

or bacteria is implicated. My lungs can't handle pollutants or toxins.

Barb