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Dr. Aishwarya Dubey

What is pleural effusion ?

Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up 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.

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Is pleural effusion serious ?

The seriousness of the condition depends on the primary cause of 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 an infection due to a virus, pneumonia or heart failure. Two factors that must be considered are treatment for associated mechanical problems as well as treatment of the underlying cause of the pleural effusion.

What are the symptoms of pleural effusion ?

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

Symptoms of pleural effusion include:

  • Chest pain

  • Dry, non-productive cough

  • Dyspnea (shortness of breath, or difficult, labored breathing)

  • Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)

 What are the types of pleural effusion ?

 

  1. Transudative pleural effusion

  2. Exudative pleural effusion 

 

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

 

  • Heart failure

  • Hepatic hydrothorax  (Liver Cirrhosis)

  • Nephrotic syndrome, hypoproteinemia and renal failure 

  • Pulmonary embolism 

  • Myxedema

 

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

 

  • Pneumonia

  • Cancer

  • Tuberculosis

  • Pancreatic disease 

  • Inflammatory and connective tissue diseases

How is pleural effusion diagnosed ?

  • Chest x-ray

  • Computed tomography (CT) scan of the chest

  • Ultrasound of the chest

  • Thoracentesis (a needle is inserted between the ribs to remove a biopsy, or sample of fluid)

  • Pleural fluid analysis (an examination of the fluid removed from the pleura space)

When the pleural effusion has remained undiagnosed despite previous, less-invasive tests, thoracoscopy may be performed. Thoracoscopy is a minimally invasive technique, performed under local anesthesia that allows for a visual evaluation of the pleura and biopsy of the pleura.

How is pleural effusion treated ?

  1. Treatment of pleural effusion is based on the treatment of the underlying condition and whether the effusion is causing severe respiratory symptoms, such as shortness of breath or difficulty breathing.

  2. Diuretics and other heart failure medications are used to treat pleural effusion caused by congestive heart failure or other medical causes.

  3. A malignant effusion may  require treatment with chemotherapy, radiation therapy or a medication infusion within the chest.

  4. A pleural effusion that is causing respiratory symptoms may be drained using therapeutic thoracentesis or through a chest tube (called tube thoracostomy).

 

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Surgery

Video-assisted thoracoscopic surgery (VATS)

A minimally-invasive approach that is completed through 1 to 3 small (approximately ½ -inch) incisions in the chest. Also known as thoracoscopic surgery, this procedure is effective in managing pleural effusions that are difficult to drain or recur due to malignancy or cancer.

 

Thoracotomy

A thoracotomy is performed through a 6- to 8-inch incision in the chest and is recommended for pleural effusions when infection is present. A thoracotomy is performed to remove all of the fibrous tissue and aids in evacuating the infection from the pleural space. Patients will require chest tubes for 2 days to 2 weeks after surgery to continue draining fluid.

 THE HOSPITAL THAT CARES

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