Fluid and Air Build up in the lungs - #16642

The presence of ongoing fluid drainage through a Heimlich valve for seven years suggests a persistent issue that requires careful evaluation. The valve is typically used for long-term management of persistent pneumothorax or pleural effusion, functioning to allow air or fluid to exit the pleural space. The consistent drainage of 100ml every morning, combined with increasing pain during dressing changes, raises concerns about chronic pleural effusion or a non-healing pneumothorax. Potential causes could include pleural infection (empyema), malignant pleural effusion, or unresolved lung disease that may be leading to continuous fluid accumulation. It’s also possible that underlying lung conditions, such as heart failure, liver cirrhosis, or chronic infections, contribute to this prolonged drainage. It’s crucial to address both the immediate symptom of pain and the underlying cause of continued fluid buildup. A worsening pain might indicate complications, such as infection around the valve site or irritation within the pleural cavity, both requiring prompt attention. Multidisciplinary management involving a pulmonologist, perhaps even surgical consultation if structural lung issues are present, may be warranted. I think you should discuss these symptoms with your healthcare provider, who may consider imaging studies, such as chest X-ray or CT scan, alongside blood tests and perhaps pleural fluid analysis to determine the nature of the effusion or related underlying conditions. Addressing any complicating factors, like infection or cancer, and reviewing any potential adjustments to your valve or treatment strategy will be critical to your recovery and comfort.

Hello Richard I understand how frustrating and painful this must be for you. Having a Heimlich valve with continuous drainage for over 7 years is very unusual and suggests a long-standing underlying issue that hasn’t fully resolved.

Possible Reasons for Ongoing Drainage- - Chronic infection or abscess:Sometimes, infections in the chest or lung can create a persistent pocket of fluid (like an empyema) that keeps draining. - Chronic pleural effusion: Conditions like heart failure, kidney disease, or certain cancers can cause ongoing fluid buildup in the chest. - Bronchopleural fistula: This is an abnormal connection between the airways and the pleural space, which can cause continuous air or fluid leakage. - Non-healing wound or cavity:Sometimes, the body forms a cavity that doesn’t close, especially if there’s ongoing inflammation or infection.

Why the Pain? Pain during dressing changes could be due to: - Skin irritation or infection around the tube site - Scar tissue formation - Nerve sensitivity from long-term tube placement

What Should You Do? - You need a thorough re-evaluation by a chest specialist (pulmonologist or thoracic surgeon). They may suggest imaging (like a CT scan) and tests on the fluid to find the exact cause. - Long-term drainage like this is not normal, and there may be better options for your comfort and health.

Thank you

Hi Richard, I’m really sorry you’ve been struggling with this for so many years. Your situation is not normal and you need further evaluation.

Get these tests done and consult with a Respiratory Medicine(Chest) Specialist.

Tests - Chest X-ray PA view, CECT of Chest, Pleural Fluid Analysis (protein, LDH, ADA, cytology, culture), Ultrasound of Chest, TB Gene Xpert.

Feel free to reach out again.

Regards, Dr. Nirav Jain MBBS, DNB D.Fam.Med