What is pleural effusion? Pleural effusion sometimes referred to as “fluid in the lungs,” is the accumulation of excess fluid between layers of pleura outside the lungs. The pleura are a thin layer that connects the lungs to the inside of the chest and works to lubricate and make it easier to breathe. Generally, a small amount of fluid is present in the pleura. Is pleural effusion critical? The severity of the condition depends on the underlying cause of the pleural effusion, whether breathing is affected, and whether it can be treated properly. Causes of pleural effusion effluent that can be treated or controlled effectively include infection due to infection, pneumonia or heart failure. Two factors to consider are the treatment of associated mechanical problems and the treatment of the root cause of pleural effusion. What are the symptoms of pleural effusion? Some patients with pleural effusion have no symptoms, in the form of a chest x-ray performed for another reason. The patient may have unrelated symptoms due to an illness or condition that caused the discharge. Symptoms of pleural effusion include: Chest pain, Dry, non-productive cough, Dyspnea (shortness of breath, or difficulty breathing), Orthopnea (inability to breathe easily unless a person is sitting upright or standing upright). What causes pleural effusion? Pleural effusions are very common, with about 100,000 cases occurring in the United States each year, according to the National Cancer Institute. Depending on the cause, excess fluid may be protein-poor (transudative) or high in protein (exudative). These two stages help physicians determine the cause of pleural effusion. The most common causes of transudative (watery fluid) pleural effusions include: Heart failure, Pulmonary embolism, Cirrhosis, Post open heart surgery, Exudative (protein-rich fluid) pleural effusions are usually caused by: Pneumonia, Cancer, Pulmonary embolism, Kidney disease, Inflammatory disease. Other common causes of pleural discharge include: Tuberculosis, Autoimmune disease, bleeding (due to chest injury), Cylothorax (due to injury), unusual chest and stomach infections, Asbestos pleural effusion (due to exposure to asbestos), Meig’s syndrome (due to a non-ovarian tumor), ovarian hyperstimulation syndrome. Certain medications, abdominal surgery and radiation therapy may also cause pleural effusion. Pleural effusion can be associated with several types of cancer including lung cancer, breast cancer and lymphoma. In some cases, the fluid itself may be harmful (cancer), or it may be a direct result of chemotherapy. How is pleural effusion diagnosed? Common tests used to diagnose and evaluate pleural effluent include: Chest x-ray, Computed tomography (CT) chest scan, Chest Ultrasound, Thoracentesis (needle inserted between ribs for biopsy, or fluid sample), pleural fluid analysis (examination of fluid extracted from pleura space). When pleural effusion has remained undiagnosed despite previous tests, very small, thoracoscopy may be performed. Thoracoscopy is a minimally invasive procedure, also known as video-assisted thoracoscopic surgery, or VATS, performed under general anesthesia that allows visual inspection of the pleura). Often, effusion treatment is combined with a diagnosis of these conditions. How is pleural effusion treated? Treatment of pleural effusion is based on the underlying condition and whether the leak is causing severe respiratory symptoms, such as shortness of breath or difficulty breathing. Diuretics and other heart failure medications are used to treat pleural inflammation caused by joint heart failure or other medical causes. Harmful effusion may require chemotherapy, radiation, or chemotherapy. The pleural effusion that causes respiratory symptoms may be removed using thoracentesis treatment or a thoracic tube (called a tube thoracostomy). In patients with uncontrolled or recurrent pleural inflammation due to a serious illness despite the flow of fluid, a sclerosing agent (a type of drug that intentionally causes scars) may occasionally be inserted into the pleural canal by thoracostomy of the tube to form fibrosis (fibrous tissue). Pleural sclerosis caused by sclerosing agents (such as talc, doxycycline, and tetracycline) was 50 percent effective in preventing recurrence of pleural effusions. Can you prevent pleural effusion? The development of pleural effusion can sometimes be prevented by early treatment of the causes listed above. However, in some cases, the development of pleural effusions may not be prevented. Some pleural effusions may be prevented from recurring by people performing pleurodesis, a process that closes the pleural space.
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