A pleural effusion is the accumulation of an abnormal amount of fluid in between tissues of the lung and chest cavity called the pleura. They can be the result of a number of conditions. By themselves, pleural effusions aren’t serious, but they should be treated.
There are two main types of pleural effusion:
Transudative — This type of pleural effusion occurs when there is an imbalance between the fluids produced and the fluids being removed. This effusion is typically clear and is more common in congestive heart failure.
Exudative — The fluid in this type of pleural effusion is cloudy and a likely sign of mesothelioma. The liquid buildup is made up of cells, proteins and other fluids reminiscent of a diseased pleura.
Causes of Pleural Effusions
In pleural effusions, fluid builds up in the areas between the layers of the pleura, the membrane that lines the outside of the lungs and the inside of the chest outside the lungs. The amount of fluid that is normally present in the pleura is as little as a teaspoon. This fluid helps the lungs move easily inside the chest cavity during breathing.
There are a number of underlying medical conditions that can cause a pleural effusion. These include:
- Heart failure
- Liver diseases like cirrhosis
- Renal diseases
- Pulmonary embolism
- Autoimmune conditions like lupus
The extra amount of fluid accumulates because the body does not process fluids the way it should, as with congestive heart failure and kidney and liver diseases. Inflammations caused by things like pneumonia and autoimmune diseases can also account for the fluid buildup in a pleural effusion.
Symptoms of Pleural Effusions
There may be no symptoms with a pleural effusion. There is more likely to be symptoms if the effusion is moderate to large in size or if it results in inflammation. Symptoms that a pleural effusion may cause include:
- Shortness of breath
- Chest pain, particularly when breathing deeply
- Inflammation of the pleura (pleurisy)
Symptoms of the underlying condition will also be present along with the pleural effusion symptoms.
Treatment of Pleural Effusions
Treating a pleural effusion usually means treating the condition that is causing it. For instance, for a pleural effusion brought on by pneumonia, antibiotics would be given. Diuretics would be prescribed for a pleural effusion caused by congestive heart failure.
Sometimes, as with complicated pleural effusions, they can become quite large and infected and it becomes necessary to drain the fluid in order to ease the symptoms and stop any complications. There are a variety of procedures used to drain a pleural effusion:
Thoracentesis — This procedure is done by inserting a needle and a catheter into the pleural space. Large amounts of fluid can be removed this way and is an effective way to treat pleural effusions.
Tube Thoracotomy — A small plastic chest tube in inserted into a small incision made in the wall of the chest. These tubes have suction attached to them and may be left in place for several days.
Pleurodesis — In this procedure a chest tube is inserted and an irritating substance like talc is injected into the pleural space. This substance inflames the pleura as well as the chest wall and they bind to each other in order to heal. This treatment is one that can prevent pleural effusions from occurring again.
Pleural Drain — These treatments are for those pleural effusions that continuously recur. A long-term catheter may be inserted into the pleural space so that the patient can drain the effusion at home.
Pleural Decortication — This is a procedure where potentially dangerous unhealthy tissue and inflammation is removed surgically.