A pleural effusion is an unusualamount of fluid around the lung.There are many medicalconditions that can lead to it. Soeventhough your pleural effusionmay have to be drained, yourdoctor likely will target thetreatment at whatever caused it.
The pleura is a thin membranethat lines the surface of the lungsand the inside of the chest walloutside the lungs. In pleuraleffusions, fluid builds up in thespace between the layers of pleura.
Normally, only teaspoons of watery fluid are in the pleural space, allowingthe lungs to move smoothly within the chest cavity during breathing.
Causes
A wide range of things can cause a pleural effusion. Some of the morecommon ones are:
- Leakage from other organs: This is usually from congestive heartfailure (when your heart doesn’t pump blood to your body properly).But it can also come from liver or kidney disease when fluid builds up inyour body and leaks into the pleural space.
- Cancer: Usually lung cancer is the problem, but other cancers that havespread to the lung or pleura can cause it, too.
- Infections: Examples are pneumonia or tuberculosis.
- Autoimmune conditions: Examples are lupus or rheumatoid arthritis.
- Pulmonary embolism: This is a blockage in an artery in one of yourlungs.
Symptoms
You might not have any. You’re more likely to have symptoms when a pleuraleffusion is moderate or large-sized, or if inflammation is present.
If you do have symptoms, they may include:
- Shortness of breath
- Chest pain, especially on breathing in deeply (pleurisy, or pleuritic pain)
- Fever
- Cough
Types
Doctors use the terms “transudative” and “exudative” to describe the two main types of pleural effusions:
Transudative: This pleural effusion fluid is similar to the fluid you normally have in your pleural space. It forms from liquid leaking across normal pleura. This type of pleural effusion rarely needs to be drained unless they are very large. Congestive heart failure is the most common cause of this type of effusion.
Exudative: This effusion forms from excess liquid, protein, blood, inflammatory cells or sometimes bacteria leaking across damaged blood vessels into the pleura. It may need to be drained, depending on its size and how much inflammation is involved. Among its causes are pneumonia and lung cancer.
Treatment
Your doctor may need to treat only the medical condition that caused the pleural effusion. You would get antibiotics for pneumonia, for instance, or diuretics for congestive heart failure.
Large, infected, or inflamed pleural effusions often need to be drained to help you feel better and to prevent more problems. Procedures for treating pleural effusions include:
- Thoracentesis: If the effusion is large, your doctor may take more fluid than she needs for testing, just to ease your symptoms.
- Tube thoracostomy (chest tube): The doctor makes a small cut in your chest wall, and inserts a plastic tube into your pleural space for several days.
- Pleural drain: For pleural effusions that keep coming back, you may get a long-term catheter inserted through your skin into the pleural space. You can drain the pleural effusion at home. Your doctor will tell you how and when to do that.
- Pleurodesis: Your doctor injects an irritating substance (such as talc or doxycycline) through a chest tube into the pleural space. The substance inflames the pleura and chest wall, which then bind tightly to each other as they heal. Pleurodesis can prevent pleural effusions from coming back, in many cases.
- Pleural decortication: Surgeons can operate inside the pleural space, removing potentially dangerous inflammation and unhealthy tissue. To do this, your surgeon may make small cuts (thoracoscopy) or a large one (thoracotomy).
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