Pleural Effusion: Causes, Symptoms, Diagnosis, Treatment, and Prevention
In pleural effusion, excess fluid accumulates in the space between the lungs and the chest wall, called the pleural cavity. This fluid can interfere with normal breathing, causing chest pain, coughing, and shortness of breath. There are many possible causes of pleural effusion, ranging from heart failure to infection to cancer. Here's how to diagnose, treat, and prevent pleural effusion.
Causes of Pleural Effusion
Pleural effusion can be classified into two types: transudative and exudative. Transudative pleural effusion occurs when fluid leaks into the pleural cavity due to increased pressure in the blood vessels. This can happen in conditions such as:
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Congestive heart failure
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Cirrhosis or liver failure
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Kidney disease
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Malnutrition
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Peritoneal dialysis
Exudative pleural effusion occurs when fluid accumulates in the pleural cavity due to inflammation, infection, or injury of the pleura or the lungs. This can happen in conditions such as:
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Pneumonia
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Tuberculosis
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Cancer
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Pulmonary embolism or blood clot in the lung
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Autoimmune diseases such as lupus and rheumatoid arthritis
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Trauma or surgery
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Certain medications such as methotrexate, phenytoin, or amiodarone
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Radiation therapy
Symptoms of Pleural Effusion
When a pleural effusion is small and does not affect breathing, some people may not experience any symptoms. Symptoms such as fever, cough, or weight loss may be the only symptom of the underlying condition that caused the effusion. If, however, the effusion is large or compresses the lungs, symptoms may include:
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Chest pain, usually sharp and worse with breathing or coughing
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Shortness of breath or difficulty breathing, especially when lying down
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Cough, dry or productive
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Fever
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Rapid or shallow breathing
Diagnosis of Pleural Effusion
A physical examination, imaging tests, and laboratory tests can be used to diagnose pleural effusion. Physical examinations reveal symptoms such as reduced chest expansion, dullness to percussion, and decreased breathing sounds. The presence and extent of fluid in the pleural cavity can be determined by chest X-rays, ultrasounds, and CT scans. Laboratory tests can analyze the fluid obtained by a procedure called thoracentesis, which involves inserting a needle into the pleural cavity and draining some fluid. The fluid can be examined for its appearance, protein content, cell count, bacteria, and other markers to determine the cause and type of pleural effusion.
Treatment of Pleural Effusion
The treatment of pleural effusion depends on the cause, type, and severity of the condition. The main goals of treatment are to relieve symptoms, remove excess fluid, and prevent recurrence. Treatment options include:
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Infections can be treated with antibiotics, fluid overload with diuretics, inflammation with anti-inflammatory drugs, and pain with painkillers. The underlying condition that caused the effusion, such as heart failure, kidney disease, or cancer, can also be treated with medications.
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Thoracentesis: This procedure involves inserting a needle into the pleural cavity to drain excess fluid and diagnose the cause of the effusion. Thoracentesis is a one-time procedure that can be repeated a number of times.
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A chest tube is inserted into the pleural cavity to drain fluid continuously. When large or recurrent effusions do not respond to medications or thoracentesis, this procedure can be performed. Fluid can be collected by connecting the tube to a suction device or a bottle. It is possible to remove the tube once the fluid stops draining or the underlying condition is treated.
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A chemical or a drug is injected into the pleural cavity to seal it and prevent fluid from building up. A chemical or a drug can cause inflammation and scarring of the pleura, which can cause the space to close and become inflamed. This procedure is used for recurrent or malignant effusions that do not respond to treatment. Through a small incision, a thoracoscope or chest tube can be inserted into the pleural cavity for pleurodesis. A thoracoscope has a camera and light.
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In order to treat the effusion, part or all of the pleura or lung are removed. The process is often used to treat complicated or persistent effusions that do not respond to other treatments. Tumors or other masses that cause the effusion may also be removed by surgery. As a minimally invasive technique, video-assisted thoracoscopic surgery (VATS) uses a thoracoscope and small incisions in the chest to perform surgery. A thoracotomy is a large incision in the chest.
Prevention of Pleural Effusion
Pleural effusion can be prevented by treating and controlling the underlying condition that causes it, such as heart failure, kidney disease, or cancer. Other preventive measures include:
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Quitting smoking
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Avoiding exposure to asbestos or other lung irritants
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Getting vaccinated for pneumonia and influenza
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Seeking medical attention for chest pain, shortness of breath, or cough
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Following up with regular check-ups and tests
Summary
An excess amount of fluid accumulates between the lungs and the chest wall in the form of pleural effusion. It can be caused by heart failure, infection, or cancer. The symptoms include chest pain, shortness of breath, and coughing. An examination, imaging tests, and laboratory tests can diagnose it. It can be treated with medications, thoracentesis, chest tubes, pleurodesis, or surgery. By treating the underlying condition, quitting smoking, avoiding lung irritants, getting vaccinated, and seeking medical attention, it can be prevented.
