What is pleural effusion?
Pleural effusion, also called
“water on the lung,” is an excessive buildup of fluid in the space between your
lungs and chest cavity. Thin membranes, called pleura, cover the outside of the
lungs and the inside of the chest cavity. There’s always a small amount of
liquid within this lining to help lubricate the lungs as they expand within the
chest during breathing.
Certain medical conditions
can cause a pleural effusion.
Pleural effusions are common,
1.5 million cases diagnosed in the United States every year, according to the American
Thoracic Society. It is a serious condition associated with an increased risk
of death. One study has shown that 15
percent of hospitalized patients diagnosed with pleural
effusions die within 30 days.
How does pleural effusion develop?
The pleura creates too much
fluid when it’s irritated or infected. This fluid accumulates in the chest
cavity outside the lung, causing what’s known as a pleural effusion.
Certain types of cancer can
cause pleural effusions. Lung and breast cancer are the most common causes.
Other causes of pleural
- congestive heart failure
- cirrhosis, or poor liver function
- pulmonary embolism, which is caused by a blood
clot and is a blockage in the lung arteries
- open heart surgery complications
- severe kidney disease
Types of pleural effusions
There are several types of
pleural effusions, with different causes and treatment options. The first
classification of pleural effusions is transudative pleural effusions and
exudative pleural effusions.
effusions are caused by fluid leaking into the pleural space as a result of
either a low blood protein count or increased pressure in the blood vessels.
Its most common direct cause is congestive heart failure.
Exudative effusions are
caused by blocked lymph or blood vessels, inflammation, tumors, or lung injury.
Common conditions that could result in this type of pleural infusion include
pulmonary embolisms, pneumonia, and fungal infections.
There are also complicated
and uncomplicated pleural effusions. Uncomplicated pleural effusions contain
fluid without signs of infection or inflammation. They’re much less likely to
cause permanent lung problems. Complicated pleural effusions, however, contain
fluid with significant infection or inflammation. They require prompt treatment
that frequently includes chest drainage.
Symptoms and signs of pleural effusion
Some people show no symptoms
of pleural effusion. These people usually find out they have the condition
through chest X-rays or physical examinations ordered for another reason.
Common symptoms of pleural
- chest pain
- dry cough
- difficulty breathing when lying down
- shortness of breath
- difficulty taking deep breaths
- persistent hiccups
See your doctor immediately
if you have symptoms of pleural effusion.
Diagnosing pleural effusion
Your doctor will perform a
physical examination and listen to your lungs with a stethoscope. They may also
order a chest X-ray to help diagnose pleural effusion. Other possible tests
- CT scan
- chest ultrasound
- pleural fluid analysis
In a pleural fluid
analysis, your doctor will remove fluid from the pleural membrane area by
inserting a needle into the chest cavity and suctioning the fluid into a
syringe. The procedure is called a thoracentesis. They’ll then test the fluid to
determine the cause.
Your doctor may schedule a
thoracoscopy if they discover you have a pleural effusion, but they’re unable
to diagnose which type. A thoracoscopy is a surgical procedure that lets the
doctor see inside the chest cavity using a fiber optic camera.
Your doctor will make a few
small incisions in the chest area while you’re under general anesthesia. Then
they’ll insert the camera through one incision and the surgical tool through
the other to extract a small amount of fluid or tissue for analysis.
Treating pleural effusion
The underlying cause of the
condition and the severity of the effusion will determine treatment.
Generally, treatment involves
draining the fluid from the chest cavity, either with a needle or a small tube
inserted into the chest. You’ll receive a local anesthetic before this
procedure, which will make the treatment more comfortable. You may feel some
pain or discomfort at the incision site after the anesthetic wears off. Most
doctors will prescribe medication to help relieve pain. You may need this
treatment more than once if fluid re-collects.
Other treatments may be necessary
to manage fluid buildup if cancer is the cause of the pleural effusion.
Pleurodesis is a treatment
that creates mild inflammation between the lung and chest cavity pleura. After
drawing the excess fluid out of the chest cavity, a doctor injects a drug into
the area. The drug is often talc. This medication causes the two layers of the
pleura to stick together and prevents the buildup of fluid between the two
layers by getting rid of the space between them.
In more serious cases, a
doctor surgically inserts a shunt, or small tube, into the chest
cavity. This helps redirect the fluid from the chest to the abdomen, where it
can be easily removed. Pleurectomy, in which part of the
pleural lining is surgically removed, is also an option in very severe cases.
Treatment for minor cases of
pleural effusion is minimally invasive. Most people recover within a few days.
Minor complications from treatment include slight pain and discomfort, which
often go away with time. Some cases of pleural effusion can have more serious
complications, depending on the severity of the condition and treatment
- pulmonary edema or fluid in the lungs, which can
result from draining fluid too quickly during thoracentesis
- partial collapsed lung
- infection or bleeding
These complications, while
serious, are very rare. Your doctor will help determine the most effective
treatment option and will discuss the benefits and risks of each procedure.
Pleural effusions and cancer
Pleural effusions can be the
result of cancer cells spreading to the pleura. They can also be the result of
cancer cells blocking the flow of normal fluid within the pleura. Fluid may
build up as a result of certain cancer treatments, such as radiation therapy or
chemotherapy, as well.
Certain cancers are more
likely to cause pleural effusions than others, including:
- lung cancer
- breast cancer
- ovarian cancer
- cervical cancer
- uterine cancer
and symptoms include:
is often used as a treatment for the malignant pleural effusions caused by
cancer. Antibiotics may also be used if you have or are susceptible to an
infection. Steroids or other anti-inflammatory medications may be used to
reduce pain and inflammation.
addition to treating the pleural effusion, your doctor will treat the cancer
that caused it. Pleural effusions are typically the result of metastatic
who are undergoing treatment for cancer may also have compromised immune
systems, making them more prone to infections or other complications.
Pleural effusions can be
serious and life-threatening. Many require hospitalized treatment, and some
require surgery. The time it takes to recover from pleural effusions depends on
the cause, size, and severity of the effusion, as well as your overall health.
You will begin your recovery
in the hospital, where you’ll receive the necessary medication and care to help
you begin to recover. Many people report feeling tired and weak in the first
week after they’ve been discharged from the hospital. On average, you will see
your incision sites from surgery heal within two to four weeks.