Pleural effusion: Causes, Symptoms, Diagnosis and Treatment

What does it consist of?

Pleural effusion, sometimes called “water in the lungs,” is the accumulation of excess fluid between the layers of the pleura outside the lungs.

The pleura are thin membranes that line the lungs and the inside of the thoracic cavity and act to lubricate and facilitate breathing. Normally, a small amount of fluid is present in the pleura.

Causes

Pleural effusions are very common, with approximately 100,000 cases diagnosed in the United States each year, according to the National Cancer Institute .

Depending on the cause, the excess fluid may be poor in proteins (transudative) or rich in proteins (exudative). These two categories help doctors determine the cause of the pleural effusion.

The most common causes of transudative pleural effusions (aqueous fluid) include:

– Heart failure –
Pulmonary embolism –
Cyrrosis –
Open heart surgery

Exudative pleural effusions (protein rich fluid) are most commonly caused by:

-Neumonia-
Cancer-
Pulmonary
embolism-Kidney
disease-Inflammatory disease

Other less common causes of pleural effusion include:

– Tuberculosis
– Autoimmune
disease – Bleeding (due to trauma to the chest) –
Chylothorax (due to trauma) –
Rare chest and abdominal
infections – Pleural asbestos drip (due to asbestos exposure) –
Meig’s syndrome (due to to a benign ovarian tumor) –
Ovarian hyperstimulation syndrome

Certain medications, abdominal surgery and radiation therapy can also cause pleural effusions. Pleural effusion can occur with several types of cancer, including lung cancer, breast cancer, and lymphoma.

In some cases, the fluid itself may be malignant (cancerous) or may be a direct result of chemotherapy.

The severity of the condition depends on the main cause of the pleural effusion, if the breathing is affected or if it can be treated effectively. The causes of pleural effusion that can be treated or controlled effectively include, an infection due to a virus, pneumonia or heart failure.

Two factors that must be considered are the treatment of the associated mechanical problems, as well as the treatment of the underlying cause of the pleural effusion.

What are the symptoms of pleural effusion?

Some patients with pleural effusion have no symptoms, and it is only discovered by a chest x-ray. Some may have symptoms unrelated to the disease or condition that caused the stroke.

Symptoms of pleural effusion include:

-Brown pain
-Tos dry and not productive
-Disease (shortness of breath or shortness of breath)
-Orthopnea (the inability to breathe easily unless the person is sitting straight or upright)

How is it diagnosed?

The most commonly used tests to diagnose and evaluate pleural effusion include:

-Braided chest
x- ray-Chest computed tomography (CT)
-Ultrasound of the chest
-Toracentesis (a needle is inserted between the ribs to extract a biopsy or fluid sample)
-Analysis of the pleural fluid (examination of the fluid extracted from the pleural space)
– When the pleural effusion has not been diagnosed despite previous and less invasive tests, thoracoscopy can be performed.

Thoracoscopy is a minimally invasive technique, also known as video-assisted thoracoscopic surgery, or VATS, performed under general anesthesia that allows a visual evaluation of the pleura. Often, the treatment of the effusion is combined with the diagnosis in these cases.

Treatment

Treatment of pleural effusion is based on the underlying condition and if the effusion is causing severe respiratory symptoms, such as difficulty breathing.

Diuretics and other medications for heart failure are used to treat pleural effusion caused by congestive heart failure or other medical causes. A malignant effusion may also require treatment with chemotherapy, radiation therapy, or an infusion of medications into the chest.

A pleural effusion that is causing respiratory symptoms can be drained by a therapeutic thoracocentesis or by a chest tube (called a thoracostomy by tube).

For patients with uncontrollable or recurrent pleural effusions due to malignancy, a sclerosing agent (a type of drug that deliberately induces scarring) can be used and can occasionally be placed in the pleural cavity through a tube thoracostomy to create a fibrosis ( excessive fibrous tissue) of the pleura (pleural sclerosis).

Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline, and tetracycline) has a 50 percent success in preventing the recurrence of pleural effusions.

Surgery

Pleural effusions that can not be treated by drainage or pleural sclerosis may require surgical treatment.

The two types of surgery include:

Video-assisted thoracoscopic surgery (VATS)

A minimally invasive approach that is completed with 1 to 3 small incisions (approximately ½ inch) in the chest.

Also known as thoracoscopic surgery, this procedure is effective in the management of pleural effusions that are difficult to drain or recur due to malignancy. Sterile talc or an antibiotic can be inserted at the time of surgery to prevent the recurrence of fluid accumulation.

Thoracotomy (also known as traditional “open” thoracic surgery).

The thoracotomy is done through a 6 to 8 inch incision in the chest and is recommended for pleural effusions when there is infection. A thoracotomy is performed to remove all the fibrous tissue and auxiliary material to evacuate the infection of the pleural space.

Patients will need chest tubes for 2 days to 2 weeks after surgery to continue draining the fluid.

Your surgeon will carefully evaluate you to determine the safest treatment option and discuss the possible risks and benefits of each of them.