Pleural Effusion

Pleural effusion is fluid collecting in the chest cavity, compressing the lung. Pleural effusion occurs when excess fluid builds up between the layers of tissue (pleura) that line the outside of the lungs and walls of the chest (thoracic) cavity. Too much fluid in the pleural space can make breathing hard or painful.

Causes

  • Pneumonia
  • Cancer
  • Congestive heart failure
  • Blood clot in the lung (pulmonary embolism)
  • Liver disease (cirrhosis)
  • Heart surgery
  • Kidney disease (renal failure)
  • Autoimmune disorder, such as rheumatoid arthritis

Symptoms

  • Sharp pains in the chest, especially when taking a breath, coughing, or sneezing
  • Trouble breathing
  • Cough
  • Fever

Diagnosing Pleural Effusion

  • Physical exam
  • Chest X-ray
  • CT scan of chest
  • Ultrasound of chest 
  • Thoracentesis: a procedure during which a small needle is inserted between the ribs to remove a sample of fluid for analysis

Treatments

  • Extra fluid may be drained from the pleural space by thoracentesis. In some cases, a tube is placed in the chest to drain the extra fluid and typically stays in place for several days.
  • A minimally invasive surgery technique known as thoracoscopy or video-assisted thoracoscopic surgery (VATS), performed under general anesthesia, can manage recurring or hard-to-drain pleural effusion. Doctors can also use this procedure to diagnose pleural effusion if less invasive tests have been unsuccessful.
  • To treat pleural effusion that is uncontrollable or recurs due to cancer despite drainage, a tunneled pleural catheter, which allows repeated drainage as needed at home, may be inserted. Another option is to instill a scarring or sclerosing agent, a type of drug that deliberately induces scarring, into the pleural cavity through a tube (thoracostomy), either in the operating room or at bedside, to fuse the lung lining and chest wall, obliterating the space where fluid recollected. 
  • If pleural effusion is caused by a bacterial infection, antibiotics will be prescribed. If pleural effusion is caused by a heart condition, other medications will be prescribed. 

If untreated, pleural effusion can lead to serious health problems, such as a chronically collapsed lung (trapped lung).