Pleural Effusion: Symptoms, Causes, Prevention, and Treatment

What is Pleural Effusion?

Sometimes referred to as “water on the lungs”, it 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 chest cavity and act to lubricate and facilitate breathing. Normally, a small amount of fluid is present in the pleura.

The severity of the condition depends on the primary cause of the pleural effusion, whether breathing is affected, and whether it can be treated effectively. Causes of pleural effusion that can be effectively treated or controlled include viral infection, pneumonia, or heart failure. Two factors to consider are treating the associated mechanical problems as well as treating the underlying cause of the pleural effusion. (Source)

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Symptoms: 

Some patients with pleural effusion have no symptoms, the condition was discovered on a chest X-ray that is done for another reason. 

Major symptoms of pleural effusion include:

1. Pain in the chest
2. Dry, non-productive cough
3. Dyspnea that is, shortness of breath or difficulty breathing, or orthopnea an inability to breathe easily if the person is not sitting or standing upright. 

Facts: 

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

2. Depending on the cause, the excess fluid can be either protein-poor or protein-rich. These categories help doctors determine the cause of the pleural effusion.

Causes: 

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

1. Heart Failure
2. Pulmonary embolism
3. Cirrhosis or after open heart surgery

Exudative or protein-rich fluid pleural effusions are most commonly caused by:

Pneumonia, cancer, pulmonary embolism, kidney disease, or inflammatory disease. 

Other less common causes of pleural effusion include tuberculosis, autoimmune disease, Bleeding due to chest injury or chylothorax due to trauma, or even infections.

Certain medications, abdominal surgery, and radiation therapy can also cause pleural effusions. Pleural effusion can occur in several types of cancer including lung cancer, breast cancer, and lymphoma. In some rare cases, the fluid itself may be malignant or cancerous or a direct result of chemotherapy.

Treatment: 

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

1. Chest x-ray
2. CT scan of the chest
3. Chest ultrasound
4. Thoracentesis: A needle is inserted between the ribs to take a biopsy or fluid sample.
5. Pleural fluid analysis: Examination of fluid taken from the pleural space.

Treatment for pleural effusion is based on the underlying condition and whether the effusion is causing severe respiratory symptoms, such as shortness of breath or difficulty breathing. Diuretics and other heart failure medications 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 drugs into the chest.

In patients with pleural effusions that are uncontrollable or return due to malignancy despite drainage, a sclerosing agent may occasionally be instilled into the pleural cavity through a thoracostomy tube to create fibrosis, pleura.

The two types of operations include:

1. Video-assisted thoracoscopic surgery (VATS): Also known as thoracoscopic surgery, this procedure is effective in managing pleural effusions that are difficult to drain or recur due to malignancy. Sterile talc or an antibiotic may be placed at the time of surgery to prevent the reaccumulation of fluid.

2. Thoracotomy also referred to as traditional, “open” chest surgery: A thoracotomy is performed to remove all fibrous tissue and aid in the evacuation of infection from the pleural space. Patients will need chest tubes for two days to two weeks after surgery to continue draining fluids.

Preventions: 

1. Avoid smoking altogether, and seek help if you would like to quit. 
2. Find healthy ways to manage stress, and aim for 7-8 hours of sleep a night. Maintain a healthy lifestyle. 
3. Get in the habit of washing your hands frequently to avoid exposure to viruses or bacteria.

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