Pleural Effusion

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Pleural Effusion

Pleural effusion is a condition where there is an unusual amount of fluid around your lungs. It can be caused by several medical conditions.
The pleura is a thin membrane lining the surface of your lungs and the inside of the chest wall. Normally, there are only a few teaspoons of watery fluid in the pleura space, which allows your lungs to move smoothly, in your chest cavity when you are breathing. When you suffer from pleural effusion, excess fluid builds up in the space between the layers of the pleura.

Symptoms

Sometimes patients suffering from pleural effusion show no symptoms, and the condition is discovered during a chest X-ray performed for another reason. The patient may also have unrelated symptoms due to the disease or condition causing the effusion.

The symptoms of pleural effusion include the following:

  • Chest pain
  • Shortness of breath, or difficult, labored breathing
  • Dry, nonproductive cough
  • Orthopnea (the inability to breathe properly unless a person is sitting up or standing erect)

Causes

Pleural effusion can be caused by various reasons. Some of the common ones include the following:

Leaking from other organs- This usually occurs if you have congestive heart failure when your heart is not properly pumping blood to your body. But it can also occur due to liver or kidney disease when fluid builds up in your body and can leak into the pleural space.

Pulmonary embolism- This is a blockage in an artery in one of your lungs, which sometimes leads to pleural effusion.

Infections- Pneumonia and Tuberculosis and similar ailments can also lead to pleural effusion.

Cancer- Lung cancer can lead to pleural effusion, but other cancers that have spread to the lung or pleura also cause it.

Autoimmune conditions- Diseases such as lupus or rheumatoid can cause it as well.

Types

Pleural Effusion is of two main types-

Transudative- This pleural effusion fluid is similar to the fluid which you have normally in your pleural space. It forms if a liquid is leaking across normal pleura. Unless it is large, this type rarely needs to be drained. This type of pleural effusion is generally caused by congestive heart failure.

Exudative- This type of pleural effusion forms from extra liquid, blood, inflammatory cells, or sometimes even bacteria that can leak across damaged blood vessels into the pleura. Depending on its size and how much inflammation there is, drainage may be required. Generally, lung cancer and pneumonia cause this type of pleural effusion.

Diagnosis

First, your doctor will conduct a physical exam, and to confirm the pleural effusion, he/she may recommend multiple imaging tests such as:

Chest X-ray

Pleural effusions generally appear white on X-rays, while the air space appears black.

Computed tomography (CT scan)

A CT scanner is able to take many X-rays quickly, and a computer constructs images of the entire chest, inside as well as out. CT scans can show more detail than chest X-rays do.

Ultrasound

This method involves a probe being placed on your chest which helps to create images of the inside of your body, which then shows up on a video screen. Your doctor can use the ultrasound to locate the fluid so they can get a sample to be sent for analysis.

Sometimes, your doctor may do a procedure called thoracentesis. This involves taking a little bit of the fluid to test. For this, they will need to insert a needle and a tube known as a catheter between your ribs, into the pleural space.

Treatment

In most cases, your doctor may need to treat only the medical condition which is causing your pleural effusion. You will get antibiotics if you are having pneumonia, for example.

If your pleural effusion is getting large, infected, or inflamed, then drainage is going to be required to help you feel better and avoid any complications.

Some of the procedures for treating pleural effusion include:

Thoracentesis

Although this method is used for diagnosis, if your effusion is large, your doctor may take more fluid than they require for testing, as this will help ease your symptoms.

Tube thoracostomy

This procedure involves your doctor making a small cut in your chest wall, after which he/she puts a plastic tube into your pleural space for several days.

Pleural drain

If your pleural effusions keep returning, your doctor may put a long-term catheter through your skin into your pleural space. You will be then able to drain the pleural effusion at home. For this, your doctor will provide you detailed instructions.

Pleurodesis

Your doctor will inject a substance through a chest tube into the pleural space. The substance inflames the pleura as well as the chest wall, which then bind tightly to each other as they heal. This procedure can prevent pleural effusions from coming back in most cases.

Pleural decortication

Surgeons can operate inside the pleural space, and remove any potentially dangerous inflammation as well as unhealthy tissue. To do this, your surgeon will need to make small cuts or a large one.

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