Pleural Effusion

pleural effusion

A pleural effusion means that there is a build-up of fluid between a lung and the chest wall. The pleura is a thin membrane that lines the inside of the chest wall and covers the lungs. There is normally a tiny amount of fluid between the two layers of pleura. This acts like lubricating oil between the lungs and the chest wall as they move when you breathe. A pleural effusion develops when this fluid builds up and separates the lung from the chest wall.

What are the causes of a pleural effusion?

A pleural effusion is a complication of various conditions. The following are some of the more common causes of a pleural effusion (but there are other rarer causes too):

  1. Pneumonia (lung infection), tuberculosis, and cancers may cause inflammation of the lung and pleura.
  2. Pleural effusion is an uncommon complication of rheumatoid arthritis and systemic lupus erythematosis (SLE).
  3. Heart failure
  4. A low level of protein in the blood
  5. Cirrhosis of the liver
  6. Kidney diseases
What are the symptoms?

You may feel some chest pain but a pleural effusion is often painless. The amount of fluid varies. As the effusion becomes larger, it presses on the lung, which cannot expand fully when you breathe. You may then become breathless.

Are any tests needed?

A chest X-ray usually confirms a pleural effusion. If the cause of the effusion is known then no further tests may be needed.

However, sometimes a pleural effusion is the first sign of an underlying condition. Then lung tests, blood tests, and taking a sample of the fluid and pleura to examine in the laboratory is undertaken.

What is the treatment for a pleural effusion?
  • Treating the underlying cause
  • A major part of treatment is usually directed to the underlying cause of the effusion. For example, antibiotics for pneumonia, chemotherapy or radiotherapy for cancers, etc.

  • Treating the effusion itself
  • Small effusions that cause no symptoms, or only mild symptoms, may just be left and 'observed'. Treatment is usually only needed if the effusion causes symptoms such as breathlessness.

    A large pleural effusion that makes you breathless can be drained. This is usually done by inserting a needle or tube through the chest wall.

  • Pleurodesis
  • This is where a special chemical (a 'sclerosant') is injected into the pleural space. This causes inflammation of the pleural membranes and helps them to 'stick' together. This helps to prevent fluid building up again into an effusion. Sclerosing chemicals that are commonly used include tetracycline, sterile talc and bleomycin.

  • An operation to insert a shunt (like an internal drain) to allow the fluid to drain out from the chest into the abdominal cavity. This is called a 'pleuroperitoneal shunt'. It is only occasionally used.
  • Pleurectomy.
  • This is an operation to remove the pleura. It is sometimes used in people with effusions due to cancer when other treatment options have failed.

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